Provider Demographics
NPI:1053700922
Name:NIGRO- PALLADINO, ELIZABETH (MA- SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:NIGRO- PALLADINO
Suffix:
Gender:F
Credentials:MA- SLP
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:PALLADINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:51 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-2231
Mailing Address - Country:US
Mailing Address - Phone:631-471-1890
Mailing Address - Fax:
Practice Address - Street 1:51 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-2231
Practice Address - Country:US
Practice Address - Phone:631-471-1890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024433-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist