Individual provider Active NPI

Brandon Henry Ly

  • Speech-Language Pathologist
  • Philadelphia, PA
National Provider Identifier
1417573403
Registry record updated Jun 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SL013102 Issued in PA
Practice address
1526 Lombard St
Philadelphia, PA 19146-1625
Phone
(215) 546-5960
NPI assigned
Jun 25, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 25, 2020

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 SL013102 PA Primary

Addresses

Primary practice location

1526 Lombard St
Philadelphia, PA 19146-1625

Mailing address

1526 Lombard St
Philadelphia, PA 19146-1625
Phone (215) 546-5960

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

LicenseStateTypeSpecialty
SL013102PAMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1593043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593043200000",
    "number": "1417573403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1526 LOMBARD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191461625",
            "telephone_number": "215-546-5960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1526 LOMBARD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191461625",
            "telephone_number": "215-546-5960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LY",
        "first_name": "BRANDON",
        "middle_name": "HENRY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-06-25",
        "last_updated": "2020-06-25",
        "certification_date": "2020-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "PA",
            "license": "SL013102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.