Organization
BOON SPEECH THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PISAMAI BOONYATHITISUK (SPEECH LANGUAGE PATHOLOGIST)
(917) 324-3119
Entity
Organization
Contact information
Practice address
64-05 YELLOWSTONE BLVD., 208A, FOREST HILLS, NY 11375
(917) 324-3119
Mailing address
64-05 YELLOWSTONE BLVD., 208A, FOREST HILLS, NY 11375
(917) 324-3119
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
014489
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1467692251
SPEECH LANGUAGE PATHOLOGIST
NY
Enumeration date
08/31/2012
Last updated
08/31/2012
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