Provider Demographics
NPI:1225584162
Name:SUBURBAN SPEECH CENTER
Entity Type:Organization
Organization Name:SUBURBAN SPEECH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:POLOW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-921-1400
Mailing Address - Street 1:748 MORRIS TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078
Mailing Address - Country:US
Mailing Address - Phone:973-921-1400
Mailing Address - Fax:973-921-0459
Practice Address - Street 1:748 MORRIS TPKE
Practice Address - Street 2:
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078-2623
Practice Address - Country:US
Practice Address - Phone:973-921-1400
Practice Address - Fax:973-921-0459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00007400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ41YS00007400OtherLICENSED SPEECH-LANGUAGE PATHOLOGIST