Provider Demographics
NPI:1922372374
Name:ROMAN-JIMENEZ, RUTH ASTRID (MS-CCC, SLP)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ASTRID
Last Name:ROMAN-JIMENEZ
Suffix:
Gender:F
Credentials:MS-CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SARGENT PL
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-2819
Mailing Address - Country:US
Mailing Address - Phone:917-703-2443
Mailing Address - Fax:
Practice Address - Street 1:19 SARGENT PL
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-2819
Practice Address - Country:US
Practice Address - Phone:917-703-2443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017292235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist