Provider Demographics
NPI:1487997946
Name:KURGANSKY, MARINA (MA, CCC- SLP)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:KURGANSKY
Suffix:
Gender:F
Credentials:MA, CCC- SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 79TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3707
Mailing Address - Country:US
Mailing Address - Phone:347-263-4377
Mailing Address - Fax:718-836-7405
Practice Address - Street 1:441 79TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3707
Practice Address - Country:US
Practice Address - Phone:347-263-4377
Practice Address - Fax:718-836-7405
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021850235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist