Provider Demographics
NPI:1811363591
Name:WENGROFSKY, DANIELLA
Entity type:Individual
Prefix:
First Name:DANIELLA
Middle Name:
Last Name:WENGROFSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2621
Mailing Address - Country:US
Mailing Address - Phone:516-314-7448
Mailing Address - Fax:
Practice Address - Street 1:21 JUMEL PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-4316
Practice Address - Country:US
Practice Address - Phone:212-923-3827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1811363591Medicaid