Provider Demographics
NPI:1700027380
Name:SPUTZ, EIDLE CHANA
Entity type:Individual
Prefix:MRS
First Name:EIDLE
Middle Name:CHANA
Last Name:SPUTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 CROWN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-5201
Mailing Address - Country:US
Mailing Address - Phone:917-853-6365
Mailing Address - Fax:718-773-6587
Practice Address - Street 1:585 CROWN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-5201
Practice Address - Country:US
Practice Address - Phone:917-853-6365
Practice Address - Fax:718-773-6587
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013302-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist