Provider Demographics
NPI:1942443213
Name:MANORVILLE SPEECH PATHOLOGY, PC
Entity type:Organization
Organization Name:MANORVILLE SPEECH PATHOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST, DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:RONDINELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-325-7755
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-0125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6144 ROUTE 25A
Practice Address - Street 2:SUITE 9B
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-2018
Practice Address - Country:US
Practice Address - Phone:631-325-7755
Practice Address - Fax:631-886-1419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency