| Organization Name: | EASTERN SUFFOLK SPEECH AND LANGUAGE PATHOLOGY PC |
| NPI Number: | 1497072219 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | THERESA BLANGIFORTI (DIRECTOR) |
| Mailing Address: | 47 Silas Woods Rd Manorville |
| State: | NY US |
| Postal Code: | 119493052 |
| Phone Number: | 6318716492 |
| Fax Number: | 6318781722 |
| NPI Enumeration Date: | 05/04/2010 |
| NPI Last Update Date: | 05/04/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 008637-1 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |