Provider Demographics
NPI:1457764060
Name:PULATOV, ANGELINA (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:
Last Name:PULATOV
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10240 67TH RD
Mailing Address - Street 2:APT 4M
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2663
Mailing Address - Country:US
Mailing Address - Phone:347-393-9701
Mailing Address - Fax:
Practice Address - Street 1:10240 67TH RD
Practice Address - Street 2:APT 4M
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2663
Practice Address - Country:US
Practice Address - Phone:347-393-9701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist