NPIMap

Organization Active NPI

North Shore Center for Speech, Language & Swallowing Disorders

  • Speech-Language Pathologist
  • Garden City, NY
National Provider Identifier
1023476090
Registry record updated Feb 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
06885 Issued in NY
Legal business name
NORTH SHORE CENTER FOR SPEECH, LANGUAGE & SWALLOWING DISORDERS
Practice address
585 Stewart Ave
Suite 310
Garden City, NY 11530-4783
Phone
(516) 627-3036
Fax
(516) 627-6741
NPI assigned
Feb 5, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Donna Riley Matusiak, MA, CCC/SLP
Title
Speech/ Languge Pathologist Owner
Phone
(516) 627-3036

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X 06885 NY Primary
Early Intervention Provider Agency 252Y00000X 06885 NY

Addresses

Primary practice location

585 Stewart Ave
Suite 310
Garden City, NY 11530-4783

Mailing address

585 Stewart Ave
Suite 310
Garden City, NY 11530-4783
Phone (516) 627-3036

Other identifiers 1

IdentifierTypeStateIssuer
01949875MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100330000561 NY Part B Supplier - Clinic/Group Practice 6103952049 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Westbury, NY

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
North Shore Center for Speech Language Swallowing Disorders2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

585 Stewart Ave
Ste 310
Garden City, NY 11530
Phone (212) 604-9360

1400 Old Country Rd
Ste 308
Westbury, NY 11590
Phone (516) 993-6230

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455235200000",
    "number": "1023476090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "585 STEWART AVE",
            "address_2": "SUITE 310",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115304783",
            "telephone_number": "516-627-3036",
            "fax_number": "516-627-6741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "585 STEWART AVE",
            "address_2": "SUITE 310",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115304783",
            "telephone_number": "516-627-3036",
            "fax_number": "516-627-6741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE CENTER FOR SPEECH, LANGUAGE & SWALLOWING DISORDERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-05",
        "last_updated": "2016-02-12",
        "status": "A",
        "authorized_official_last_name": "MATUSIAK",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "RILEY",
        "authorized_official_title_or_position": "SPEECH/ LANGUGE PATHOLOGIST OWNER",
        "authorized_official_telephone_number": "516-627-3036",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MA, CCC/SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "06885",
            "primary": true
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NY",
            "license": "06885",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01949875",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden City, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.