Provider Demographics
NPI:1801192075
Name:LIPSHITZ, ALEXANDRA GALBUT (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:GALBUT
Last Name:LIPSHITZ
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8656 MARENGO ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1326
Mailing Address - Country:US
Mailing Address - Phone:718-464-0718
Mailing Address - Fax:
Practice Address - Street 1:17544 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2140
Practice Address - Country:US
Practice Address - Phone:718-658-1563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020383-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist