Provider Demographics
NPI:1013286574
Name:BURNS, JUSTINE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:BURNS
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 1:2409 27TH ST
Mailing Address - Street 2:APT 4B
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-2384
Mailing Address - Country:US
Mailing Address - Phone:973-919-6760
Mailing Address - Fax:
Practice Address - Street 1:1 EXPRESSWAY PLZ
Practice Address - Street 2:SUITE 106
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2047
Practice Address - Country:US
Practice Address - Phone:516-621-2381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020447-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist