Provider Demographics
NPI:1063131886
Name:MARTHA BERTI, SLP, PC
Entity type:Organization
Organization Name:MARTHA BERTI, SLP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTI
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:631-974-0193
Mailing Address - Street 1:300 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1869
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-1869
Practice Address - Country:US
Practice Address - Phone:631-974-0193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty