Provider Demographics
NPI:1821348459
Name:GERSHKOVICH, SUZANNA (MS SLP-CCC)
Entity Type:Individual
Prefix:
First Name:SUZANNA
Middle Name:
Last Name:GERSHKOVICH
Suffix:
Gender:F
Credentials:MS SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E 16TH ST FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3706
Mailing Address - Country:US
Mailing Address - Phone:347-326-3434
Mailing Address - Fax:
Practice Address - Street 1:500 BI COUNTY BLVD
Practice Address - Street 2:SUITE 114
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3988
Practice Address - Country:US
Practice Address - Phone:718-264-1640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
NY023147235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No251C00000XAgenciesDay Training, Developmentally Disabled Services