| NPI | 1871127746 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVELYN C CUSTODIO Speech Language Pathologist 929-414-1234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Enumeration Date | 2020-02-28 |
| Last Update Date | 2020-02-28 |