Provider Demographics
NPI:1538392766
Name:REYES-PARK, MARIA (MA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:REYES-PARK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 KEW GARDENS RD APT 2C
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1110
Mailing Address - Country:US
Mailing Address - Phone:646-334-7474
Mailing Address - Fax:
Practice Address - Street 1:41 KEW GARDENS RD APT 2C
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1110
Practice Address - Country:US
Practice Address - Phone:646-334-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-04
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018031-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY018031-1OtherTHE UNIVERSITY OF THE STATE OF NEW YORK