Provider Demographics
NPI:1902205933
Name:LANGUAGE CONNECTION SLP P.C.
Entity Type:Organization
Organization Name:LANGUAGE CONNECTION SLP P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:
Authorized Official - Last Name:RYBALOV
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:917-417-7344
Mailing Address - Street 1:2388 OCEAN AVE
Mailing Address - Street 2:APT. 7
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3564
Mailing Address - Country:US
Mailing Address - Phone:917-417-7344
Mailing Address - Fax:
Practice Address - Street 1:2388 OCEAN AVE
Practice Address - Street 2:APT. 7
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3564
Practice Address - Country:US
Practice Address - Phone:917-417-7344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022591302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization