Provider Demographics
NPI:1730200437
Name:HASKELL, JOHN A (EDD, CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:HASKELL
Suffix:
Gender:M
Credentials:EDD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 MADISON AVE RM 1312
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5110
Mailing Address - Country:US
Mailing Address - Phone:646-424-9772
Mailing Address - Fax:646-424-9773
Practice Address - Street 1:171 MADISON AVE RM 1312
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5110
Practice Address - Country:US
Practice Address - Phone:646-424-9772
Practice Address - Fax:646-424-9773
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001402-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0C4825OtherHEALTHNET ID
NY513419OtherAETNA ID