Provider Demographics
NPI:1720311749
Name:ALLIED SPEECH-LANGUAGE THERAPY, P.C.
Entity type:Organization
Organization Name:ALLIED SPEECH-LANGUAGE THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOMINGO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-249-5477
Mailing Address - Street 1:399 CONKLIN ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-2614
Mailing Address - Country:US
Mailing Address - Phone:516-249-5477
Mailing Address - Fax:516-777-2821
Practice Address - Street 1:399 CONKLIN ST
Practice Address - Street 2:SUITE 303
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-2614
Practice Address - Country:US
Practice Address - Phone:516-249-5477
Practice Address - Fax:516-777-2821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003834-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1477629558OtherNPI INDIVIDUAL