Provider Demographics
NPI:1124130463
Name:CAPITAL AREA SPEECH CENTER
Entity type:Organization
Organization Name:CAPITAL AREA SPEECH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXTENSION
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:CORCORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-462-6222
Mailing Address - Street 1:339 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MENANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12204-2708
Mailing Address - Country:US
Mailing Address - Phone:518-462-6222
Mailing Address - Fax:518-462-6003
Practice Address - Street 1:339 BROADWAY
Practice Address - Street 2:
Practice Address - City:MENANDS
Practice Address - State:NY
Practice Address - Zip Code:12204-2708
Practice Address - Country:US
Practice Address - Phone:518-462-6222
Practice Address - Fax:518-462-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00546754Medicaid