Active NPI
Kristin L Gomez, M.S. SLP-CCC
- Speech-Language Pathologist
- Bay Shore, NY
National Provider Identifier
1164799680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 020175
- Practice address
- 75 W Perkal St
Bay Shore, NY 11706-6642 - Phone
- (631) 968-1232
- Fax
- (631) 968-1281
- NPI assigned
- Nov 29, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 020175 | NY | Primary |
Addresses
Primary practice location
75 W Perkal St
Bay Shore, NY 11706-6642
Mailing address
75 W Perkal St
Bay Shore, NY 11706-6642
Phone (631) 968-1232
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 020175 | Other | NY | NEW YORK STATE SPEECH PATHOLOGIST LICENSE |
Other names 1
- Miss Kristin L Griffin
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020175 | NY | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bay Shore Ufsd | Past | Accepting new patients | |
| Bay Shore Union Free School District | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Local Education Agency (LEA)
- Bay Shore, NY
- NPI 1689951428
-
- Local Education Agency (LEA)
- Bay Shore, NY
- NPI 1154478295
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1322524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624233600000",
"number": "1164799680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75 W PERKAL ST",
"city": "BAY SHORE",
"state": "NY",
"postal_code": "117066642",
"telephone_number": "631-968-1232",
"fax_number": "631-968-1281"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 W PERKAL ST",
"city": "BAY SHORE",
"state": "NY",
"postal_code": "117066642",
"telephone_number": "631-968-1232",
"fax_number": "631-968-1281"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOMEZ",
"first_name": "KRISTIN",
"middle_name": "L",
"name_prefix": "Mrs.",
"credential": "M.S. SLP-CCC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-29",
"last_updated": "2021-06-21",
"certification_date": "2021-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "020175",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEW YORK STATE SPEECH PATHOLOGIST LICENSE",
"identifier": "020175",
"state": "NY"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KRISTIN",
"last_name": "GRIFFIN",
"middle_name": "L",
"prefix": "MISS",
"credential": "M.S. SLP-CCC",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Bay Shore, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.