Provider Demographics
NPI:1255571022
Name:EZAGUI, NECHAMA DINA (SLP)
Entity type:Individual
Prefix:
First Name:NECHAMA
Middle Name:DINA
Last Name:EZAGUI
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 1:709 EASTERN PKWY APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-3465
Mailing Address - Country:US
Mailing Address - Phone:718-735-8475
Mailing Address - Fax:
Practice Address - Street 1:709 EASTERN PKWY APT 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-3465
Practice Address - Country:US
Practice Address - Phone:718-735-8475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017013235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist