Provider Demographics
NPI:1548312598
Name:MT. ST. URSULA SPEECH CENTER
Entity type:Organization
Organization Name:MT. ST. URSULA SPEECH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, DDS
Authorized Official - Phone:718-584-7679
Mailing Address - Street 1:2885 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-3012
Mailing Address - Country:US
Mailing Address - Phone:718-584-7679
Mailing Address - Fax:718-584-7954
Practice Address - Street 1:2885 MARION AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-3012
Practice Address - Country:US
Practice Address - Phone:718-584-7679
Practice Address - Fax:718-584-7954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7000229R261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00245872Medicaid