Provider Demographics
NPI:1942506084
Name:GORODETSKY, ELINA (SLP)
Entity Type:Individual
Prefix:MS
First Name:ELINA
Middle Name:
Last Name:GORODETSKY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 VILLAGE RD N
Mailing Address - Street 2:APT. 2C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4706
Mailing Address - Country:US
Mailing Address - Phone:718-974-4213
Mailing Address - Fax:
Practice Address - Street 1:71 VILLAGE RD N
Practice Address - Street 2:APT. 2C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4706
Practice Address - Country:US
Practice Address - Phone:718-974-4213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021490235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist