Provider Demographics
NPI:1366696502
Name:KORNHABER-EDER, IVY (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:IVY
Middle Name:
Last Name:KORNHABER-EDER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 KAPPOCK ST APT 306
Mailing Address - Street 2:APT. 306
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4616
Mailing Address - Country:US
Mailing Address - Phone:718-549-1312
Mailing Address - Fax:
Practice Address - Street 1:750 KAPPOCK ST APT 306
Practice Address - Street 2:APT. 306
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4616
Practice Address - Country:US
Practice Address - Phone:718-549-1312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011233-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist