Provider Demographics
NPI:1851431985
Name:JASTROW, HOWARD GARY (MA, CCC)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:GARY
Last Name:JASTROW
Suffix:
Gender:M
Credentials:MA, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7020 108TH ST
Mailing Address - Street 2:APT 9F
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4449
Mailing Address - Country:US
Mailing Address - Phone:718-520-1334
Mailing Address - Fax:
Practice Address - Street 1:7020 108TH ST
Practice Address - Street 2:APT 9F
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4449
Practice Address - Country:US
Practice Address - Phone:718-520-1334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012071-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist