Provider Demographics
NPI:1841877131
Name:FUNCTIONAL COMMUNICATION THERAPY SLP, PC
Entity type:Organization
Organization Name:FUNCTIONAL COMMUNICATION THERAPY SLP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:YANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:KABASZINSKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-509-4305
Mailing Address - Street 1:47 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3906
Mailing Address - Country:US
Mailing Address - Phone:917-509-4305
Mailing Address - Fax:
Practice Address - Street 1:47 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3906
Practice Address - Country:US
Practice Address - Phone:917-509-4305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03658968Medicaid