Provider Demographics
NPI:1770845448
Name:ADVANCED SPEECH PATHOLOGY
Entity Type:Organization
Organization Name:ADVANCED SPEECH PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMATO
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:631-482-1200
Mailing Address - Street 1:PO BOX 504
Mailing Address - Street 2:
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-0504
Mailing Address - Country:US
Mailing Address - Phone:631-482-1200
Mailing Address - Fax:
Practice Address - Street 1:500 W MAIN ST STE 208
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3032
Practice Address - Country:US
Practice Address - Phone:631-482-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN AMATO, EDD, SLP, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000087261QH0700X
NY00087261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech