Provider Demographics
NPI:1588288690
Name:DIBARI, EMILY ANN (SLP-CCC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:DIBARI
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3234
Mailing Address - Country:US
Mailing Address - Phone:516-491-0688
Mailing Address - Fax:
Practice Address - Street 1:5740 MARATHON PKWY
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-2036
Practice Address - Country:US
Practice Address - Phone:718-225-7029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029382235Z00000X
NY14344354235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist