Provider Demographics
NPI:1053729111
Name:DYNAMIC CARE ASSOCIATE LLC.
Entity type:Organization
Organization Name:DYNAMIC CARE ASSOCIATE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGAUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:REZIA
Authorized Official - Middle Name:YOSHIKA
Authorized Official - Last Name:LUKE
Authorized Official - Suffix:
Authorized Official - Credentials:SLP-CCC
Authorized Official - Phone:718-986-9306
Mailing Address - Street 1:1479 PROSPECT PL
Mailing Address - Street 2:STE 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-2490
Mailing Address - Country:US
Mailing Address - Phone:718-986-9306
Mailing Address - Fax:877-585-0047
Practice Address - Street 1:1479 PROSPECT PL
Practice Address - Street 2:STE 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-2490
Practice Address - Country:US
Practice Address - Phone:718-986-9306
Practice Address - Fax:877-585-0047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0233701235Z00000X, 251C00000X, 251S00000X, 310400000X, 3104A0630X, 320600000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty