Provider Demographics
NPI:1982702049
Name:RODIN, ALAN MARC (SLP, MA, CCC)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:MARC
Last Name:RODIN
Suffix:
Gender:M
Credentials:SLP, MA, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 920181
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-0181
Mailing Address - Country:US
Mailing Address - Phone:917-742-4089
Mailing Address - Fax:718-474-3733
Practice Address - Street 1:154 BEACH 124TH ST
Practice Address - Street 2:
Practice Address - City:BELLE HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11694-1840
Practice Address - Country:US
Practice Address - Phone:917-742-4089
Practice Address - Fax:718-474-6655
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005002-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist