Provider Demographics
NPI:1932459500
Name:DIX HILLS SPEECH PATHOLOGY & REHABILITATION, PLLC
Entity Type:Organization
Organization Name:DIX HILLS SPEECH PATHOLOGY & REHABILITATION, PLLC
Other - Org Name:DIX HILLS CENTER FOR SPEECH & HEARING DISORDERS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA SLP-CCC
Authorized Official - Phone:631-499-5404
Mailing Address - Street 1:104 MAJESTIC DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4935
Mailing Address - Country:US
Mailing Address - Phone:631-499-5404
Mailing Address - Fax:631-462-0621
Practice Address - Street 1:104 MAJESTIC DR
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-4935
Practice Address - Country:US
Practice Address - Phone:631-499-5404
Practice Address - Fax:631-462-0621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002813-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency