Provider Demographics
NPI:1427203314
Name:EHRENBERG, IRA ISRAEL (CCC-SLP/TSHH)
Entity type:Individual
Prefix:MR
First Name:IRA
Middle Name:ISRAEL
Last Name:EHRENBERG
Suffix:
Gender:M
Credentials:CCC-SLP/TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 CUMBERLAND PL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1334
Mailing Address - Country:US
Mailing Address - Phone:516-435-5955
Mailing Address - Fax:718-337-2268
Practice Address - Street 1:124 CUMBERLAND PL
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1334
Practice Address - Country:US
Practice Address - Phone:516-435-5955
Practice Address - Fax:718-337-2268
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015850235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist