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?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty