Provider Demographics
NPI:1245504539
Name:MURRAY, EUGENE RAYMOND
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:RAYMOND
Last Name:MURRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ONDERDONK RD
Mailing Address - Street 2:21 ONDERDONK RD
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-9746
Mailing Address - Country:US
Mailing Address - Phone:518-399-7225
Mailing Address - Fax:
Practice Address - Street 1:21 ONDERDONK RD
Practice Address - Street 2:21 ONDERDONK RD
Practice Address - City:GLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12302-9746
Practice Address - Country:US
Practice Address - Phone:518-399-7225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-04
Last Update Date:2012-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4113235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist