Provider Demographics
NPI:1144474057
Name:LIVSHITS, GARRY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:GARRY
Middle Name:
Last Name:LIVSHITS
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 KEENE LN
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2209
Mailing Address - Country:US
Mailing Address - Phone:516-312-6205
Mailing Address - Fax:516-673-9413
Practice Address - Street 1:832 KEENE LN
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2209
Practice Address - Country:US
Practice Address - Phone:516-312-6205
Practice Address - Fax:516-673-9413
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016084235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist