Provider Demographics
NPI:1083108005
Name:PLUTCHOK, PEREL (MA, SLP, CF)
Entity Type:Individual
Prefix:
First Name:PEREL
Middle Name:
Last Name:PLUTCHOK
Suffix:
Gender:F
Credentials:MA, SLP, CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 14TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1831
Mailing Address - Country:US
Mailing Address - Phone:347-277-6025
Mailing Address - Fax:
Practice Address - Street 1:7 BRIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4749
Practice Address - Country:US
Practice Address - Phone:732-730-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTL-3070235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist