Provider Demographics
NPI:1780826420
Name:ELAINA KABZAN CCC SLP PC
Entity Type:Organization
Organization Name:ELAINA KABZAN CCC SLP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KABZAN-VAYNMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC/SLP
Authorized Official - Phone:917-428-6059
Mailing Address - Street 1:2760 WHITMAN DR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6809
Mailing Address - Country:US
Mailing Address - Phone:917-428-6059
Mailing Address - Fax:
Practice Address - Street 1:2760 WHITMAN DR
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6809
Practice Address - Country:US
Practice Address - Phone:917-428-6059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009090251S00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251S00000XAgenciesCommunity/Behavioral Health