Provider Demographics
NPI:1336377191
Name:PIEZA, IRENE BORLAND (MS-CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:BORLAND
Last Name:PIEZA
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 1:6 PAULDING AVE
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:NY
Mailing Address - Zip Code:10516-2513
Mailing Address - Country:US
Mailing Address - Phone:917-533-1230
Mailing Address - Fax:
Practice Address - Street 1:6 PAULDING AVE
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:NY
Practice Address - Zip Code:10516
Practice Address - Country:US
Practice Address - Phone:917-533-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010425-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010425-1OtherNYS SLP LICENSE
NY010425-1OtherNYS SPEECH LANGUAGE PATHOLOGIST LICENSE