Provider Demographics
NPI:1881020717
Name:DARA KOTLER CCC-SLP, PLLC
Entity Type:Organization
Organization Name:DARA KOTLER CCC-SLP, PLLC
Other - Org Name:SPEECH ZONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:GINDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-799-1750
Mailing Address - Street 1:2112 BROADWAY
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2105
Mailing Address - Country:US
Mailing Address - Phone:212-799-1750
Mailing Address - Fax:212-799-1815
Practice Address - Street 1:2112 BROADWAY
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2105
Practice Address - Country:US
Practice Address - Phone:212-799-1750
Practice Address - Fax:212-799-1815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty