Provider Demographics
NPI:1285997197
Name:JORGE ALBEIRO LONDONO LENIS
Entity type:Organization
Organization Name:JORGE ALBEIRO LONDONO LENIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGY
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:ALBEIRO
Authorized Official - Last Name:LONDONO
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:347-755-7842
Mailing Address - Street 1:10420 QUEENS BLVD APT 12W
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3621
Mailing Address - Country:US
Mailing Address - Phone:347-755-7842
Mailing Address - Fax:
Practice Address - Street 1:10420 QUEENS BLVD APT 12W
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3621
Practice Address - Country:US
Practice Address - Phone:347-755-7842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-17
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019401235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYKBJ007L69516OtherBLUE CROSS