Provider Demographics
NPI:1912400870
Name:MATTIYAHU INC.
Entity Type:Organization
Organization Name:MATTIYAHU INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:LUCILLE
Authorized Official - Last Name:EDELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC/SLP, TSSLD-BE
Authorized Official - Phone:646-721-8903
Mailing Address - Street 1:2191 CRESTON AVE APT 5D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-2621
Mailing Address - Country:US
Mailing Address - Phone:646-721-8903
Mailing Address - Fax:
Practice Address - Street 1:2191 CRESTON AVE APT 5D
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-2621
Practice Address - Country:US
Practice Address - Phone:646-721-8903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022736-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty