Provider Demographics
NPI:1912523812
Name:PITAMBER, PARMINNE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PARMINNE
Middle Name:
Last Name:PITAMBER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4361 BOWNE ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3039
Mailing Address - Country:US
Mailing Address - Phone:718-762-8991
Mailing Address - Fax:
Practice Address - Street 1:4361 BOWNE ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3039
Practice Address - Country:US
Practice Address - Phone:718-762-8991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025561-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty