Provider Demographics
NPI:1457595472
Name:NORTH SHORE CENTER FOR SPEECH, LANGUAGE & SWALLOWING DISORDERS LLP
Entity Type:Organization
Organization Name:NORTH SHORE CENTER FOR SPEECH, LANGUAGE & SWALLOWING DISORDERS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO - DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:N/A
Authorized Official - Last Name:MATUSIAK
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:516-627-3036
Mailing Address - Street 1:585 STEWART AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4783
Mailing Address - Country:US
Mailing Address - Phone:516-627-3036
Mailing Address - Fax:516-627-6741
Practice Address - Street 1:585 STEWART AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4783
Practice Address - Country:US
Practice Address - Phone:516-627-3036
Practice Address - Fax:516-627-6741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6885252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency