Provider Demographics
NPI:1366726481
Name:CORNERSTONE SPEECH & LANGUAGE THERAPY, PC
Entity type:Organization
Organization Name:CORNERSTONE SPEECH & LANGUAGE THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHR
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:646-998-4798
Mailing Address - Street 1:1324 LEXINGTON AVE
Mailing Address - Street 2:SUITE 316
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1145
Mailing Address - Country:US
Mailing Address - Phone:646-998-4798
Mailing Address - Fax:
Practice Address - Street 1:1324 LEXINGTON AVE
Practice Address - Street 2:SUITE 316
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1145
Practice Address - Country:US
Practice Address - Phone:646-998-4798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019394252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency