Provider Demographics
NPI:1801043575
Name:ZOMBACK, ELLEN SERBER (MS CCC-SLP TSHH)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:SERBER
Last Name:ZOMBACK
Suffix:
Gender:F
Credentials:MS CCC-SLP TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 ROBERT DR
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-1718
Mailing Address - Country:US
Mailing Address - Phone:914-235-4711
Mailing Address - Fax:914-576-4044
Practice Address - Street 1:89 ROBERT DR
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-1718
Practice Address - Country:US
Practice Address - Phone:914-235-4711
Practice Address - Fax:914-576-4044
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007506-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist