Provider Demographics
NPI:1447537428
Name:AL BAYATY, WID (MSC)
Entity type:Individual
Prefix:MS
First Name:WID
Middle Name:
Last Name:AL BAYATY
Suffix:
Gender:F
Credentials:MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 WEST 55TH STREET
Mailing Address - Street 2:APT 5G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-4539
Mailing Address - Country:US
Mailing Address - Phone:191-729-1686
Mailing Address - Fax:
Practice Address - Street 1:352 7TH AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5012
Practice Address - Country:US
Practice Address - Phone:121-243-0680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CLINICAL FELLOW235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist