Provider Demographics
NPI:1407216856
Name:MICHELE PASQUALE SPEECH LANGUAGE PATHOLOGIST PC
Entity type:Organization
Organization Name:MICHELE PASQUALE SPEECH LANGUAGE PATHOLOGIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:PASQUALE
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC SLP
Authorized Official - Phone:631244-000-0754
Mailing Address - Street 1:240 SAINT LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-2111
Mailing Address - Country:US
Mailing Address - Phone:631-244-0075
Mailing Address - Fax:
Practice Address - Street 1:240 SAINT LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-2111
Practice Address - Country:US
Practice Address - Phone:631-244-0075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-27
Last Update Date:2016-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0131871252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03661561Medicaid