Individual provider Active NPI

Edward Mullen, SLP

  • Speech-Language Pathologist
  • New York, NY
National Provider Identifier
1174781041
Registry record updated May 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
014433-1 Issued in NY
Practice address
69 Bennett Ave Apt 407
New York, NY 10033-3024
Phone
(347) 920-7040
NPI assigned
May 28, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 014433-1 NY Primary

Addresses

Primary practice location

69 Bennett Ave Apt 407
New York, NY 10033-3024

Mailing address

69 Bennett Ave Apt 407
New York, NY 10033-3024
Phone (347) 920-7040

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090810000000 NY Practitioner - Qualified Speech Language Pathologist 0840343802 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
014433NYMDClinical Psychologist
014433-1NYMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Global Speech Language Pathology PC Speech-Language Pathologist CurrentSince Mar 1, 2016 Accepting new patients
Epic Medical Services PC CurrentSince Apr 1, 2016 Accepting new patients
Lifespire, Inc. Past Accepting new patients
Lifespire, Inc. Past Accepting new patients

Locations

1500 Hempstead Tpke
East Meadow, NY 11554
Phone 51673977331420

1979 Marcus Ave
Ste 204
New Hyde Park, NY 11042
Phone (516) 327-4681

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1211932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211932800000",
    "number": "1174781041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69 BENNETT AVE APT 407",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100333024",
            "telephone_number": "347-920-7040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69 BENNETT AVE APT 407",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100333024",
            "telephone_number": "347-920-7040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLEN",
        "first_name": "EDWARD",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-28",
        "last_updated": "2008-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "014433-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2008; 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.