Provider Demographics
NPI:1124302609
Name:BIAL, LESLIE ANNE (SLP)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ANNE
Last Name:BIAL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-4613
Mailing Address - Country:US
Mailing Address - Phone:516-694-2270
Mailing Address - Fax:
Practice Address - Street 1:1095 JOSELSON AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-2035
Practice Address - Country:US
Practice Address - Phone:631-434-2261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006403-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006403-1OtherNEW YORK STATE LICENSE NUMBER