Provider Demographics
NPI:1306124300
Name:BABEKOV, DANIEL M (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:M
Last Name:BABEKOV
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15910 71ST AVE
Mailing Address - Street 2:#3A
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3020
Mailing Address - Country:US
Mailing Address - Phone:917-239-4591
Mailing Address - Fax:
Practice Address - Street 1:15813 72ND AVE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-4100
Practice Address - Country:US
Practice Address - Phone:718-380-7600
Practice Address - Fax:718-820-0369
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019273-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist