Provider Demographics
NPI:1831489426
Name:OSTOW, STACY
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:OSTOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 E 80TH ST
Mailing Address - Street 2:31F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0644
Mailing Address - Country:US
Mailing Address - Phone:917-463-3713
Mailing Address - Fax:
Practice Address - Street 1:345 E 80TH ST
Practice Address - Street 2:31F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0644
Practice Address - Country:US
Practice Address - Phone:917-463-3713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013066235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist