Provider Demographics
NPI:1992066021
Name:ALTAGRACIA JORGE
Entity type:Organization
Organization Name:ALTAGRACIA JORGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ALTAGRACIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JORGE
Authorized Official - Suffix:
Authorized Official - Credentials:SPEECH PATHOLOGIST
Authorized Official - Phone:914-562-6918
Mailing Address - Street 1:258 SOMMERVILLE PL
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-2211
Mailing Address - Country:US
Mailing Address - Phone:914-562-6918
Mailing Address - Fax:914-207-8299
Practice Address - Street 1:258 SOMMERVILLE PL
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-2211
Practice Address - Country:US
Practice Address - Phone:914-562-6918
Practice Address - Fax:914-207-8299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019815252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency