Provider Demographics
NPI: | 1023580602 |
---|---|
Name: | AJ SPEECH-LANGUAGE PATHOLOGIST PC |
Entity Type: | Organization |
Organization Name: | AJ SPEECH-LANGUAGE PATHOLOGIST PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | SPEECH-LANGUAGE PATHOLOGIST |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | ANGELA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | JEFFERIES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MA,CCC-SLP,TSLD |
Authorized Official - Phone: | 347-977-7984 |
Mailing Address - Street 1: | 1461 SHORE PKWY APT 6L |
Mailing Address - Street 2: | |
Mailing Address - City: | BROOKLYN |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 11214-6126 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 347-977-7984 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1461 SHORE PKWY APT 6L |
Practice Address - Street 2: | |
Practice Address - City: | BROOKLYN |
Practice Address - State: | NY |
Practice Address - Zip Code: | 11214-6126 |
Practice Address - Country: | US |
Practice Address - Phone: | 347-977-7984 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-12-20 |
Last Update Date: | 2018-12-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Single Specialty |