Active NPI
Yudit Bolotovskaya
- Speech-Language Pathologist
- Oyster Bay, NY
National Provider Identifier
1316510951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 78157
- Practice address
- 10 Amber LN
Oyster Bay, NY 11771-3115 - Phone
- (347) 270-8850
- NPI assigned
- Jul 21, 2021
- 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 | 78157 | MA | Primary |
Addresses
Primary practice location
10 Amber LN
Oyster Bay, NY 11771-3115
Mailing address
446 E 86TH St Apt 11a
New York, NY 10028-6472
Phone (617) 595-0553
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 78157 | MA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626825600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693180800000",
"number": "1316510951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "446 E 86TH ST APT 11A",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100286472",
"telephone_number": "617-595-0553"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 AMBER LN",
"city": "OYSTER BAY",
"state": "NY",
"postal_code": "117713115",
"telephone_number": "347-270-8850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLOTOVSKAYA",
"first_name": "YUDIT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-07-21",
"last_updated": "2023-08-28",
"certification_date": "2023-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MA",
"license": "78157",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oyster Bay, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.