Provider Demographics
NPI:1528312915
Name:FISHER, IRENE PILAVAS (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:IRENE
Middle Name:PILAVAS
Last Name:FISHER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:PILAVAS
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:280 STONYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1102
Mailing Address - Country:US
Mailing Address - Phone:516-780-2068
Mailing Address - Fax:
Practice Address - Street 1:280 STONYTOWN RD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-1102
Practice Address - Country:US
Practice Address - Phone:516-780-2068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04114343Medicaid