Provider Demographics
NPI:1902442809
Name:ISLAND WIDE SPEECH S.L.P. PLLC
Entity Type:Organization
Organization Name:ISLAND WIDE SPEECH S.L.P. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:FARA
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:AUGUSTOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:516-508-2751
Mailing Address - Street 1:2539 MARTIN AVE
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-3128
Mailing Address - Country:US
Mailing Address - Phone:516-508-2751
Mailing Address - Fax:516-415-2754
Practice Address - Street 1:2539 MARTIN AVE
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-3128
Practice Address - Country:US
Practice Address - Phone:516-415-2751
Practice Address - Fax:516-415-2754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY019969-1OtherNEW YORK STATE SPEECH-LANGUAGE HEARING ASSOCIATION
12118306OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION
1861625501OtherINDIVIDUAL NPI