Provider Demographics
NPI:1972658532
Name:FARBSTEIN, RESA (MS, CCC)
Entity Type:Individual
Prefix:
First Name:RESA
Middle Name:
Last Name:FARBSTEIN
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2812 COVERED BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4817
Mailing Address - Country:US
Mailing Address - Phone:516-867-7270
Mailing Address - Fax:
Practice Address - Street 1:1 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4213
Practice Address - Country:US
Practice Address - Phone:516-877-4846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1719-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist