Provider Demographics
NPI:1932266350
Name:BEACON SPEECH-LANGUAGE PATHOLOGY PHYSICAL AND OCCUPATIONAL THERAPY
Entity Type:Organization
Organization Name:BEACON SPEECH-LANGUAGE PATHOLOGY PHYSICAL AND OCCUPATIONAL THERAPY
Other - Org Name:BEACON THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEHRER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-621-3562
Mailing Address - Street 1:1441 OLD NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2146
Mailing Address - Country:US
Mailing Address - Phone:516-632-1111
Mailing Address - Fax:516-625-0238
Practice Address - Street 1:1441 OLD NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-2146
Practice Address - Country:US
Practice Address - Phone:516-632-1111
Practice Address - Fax:516-625-0238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001225235Z00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty