Provider Demographics
NPI:1801401609
Name:ROSSANA SEDITA SPEECH LANGUAGE PATHOLOGIST PLLC
Entity Type:Organization
Organization Name:ROSSANA SEDITA SPEECH LANGUAGE PATHOLOGIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSSANA
Authorized Official - Middle Name:P
Authorized Official - Last Name:SEDITA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:718-288-4029
Mailing Address - Street 1:8 LOCUST GROVE LN
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-2714
Mailing Address - Country:US
Mailing Address - Phone:718-288-4029
Mailing Address - Fax:
Practice Address - Street 1:8 LOCUST GROVE LN
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-2714
Practice Address - Country:US
Practice Address - Phone:718-288-4029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY39680Medicaid