Provider Demographics
NPI:1851694483
Name:EASTERN LI SPEECH PATHOLOGY &SWALLOWING DISORDERS PC
Entity Type:Organization
Organization Name:EASTERN LI SPEECH PATHOLOGY &SWALLOWING DISORDERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:STIENE
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:631-689-6858
Mailing Address - Street 1:1500 WILLIAM FLOYD PKWY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:EAST YAPHANK
Mailing Address - State:NY
Mailing Address - Zip Code:11967-1800
Mailing Address - Country:US
Mailing Address - Phone:631-775-8203
Mailing Address - Fax:631-775-8202
Practice Address - Street 1:1500 WILLIAM FLOYD PKWY
Practice Address - Street 2:SUITE 303
Practice Address - City:EAST YAPHANK
Practice Address - State:NY
Practice Address - Zip Code:11967-1800
Practice Address - Country:US
Practice Address - Phone:631-775-8203
Practice Address - Fax:631-775-8202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011861235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty