Provider Demographics
NPI:1346699246
Name:SKAIST, BRACHA
Entity Type:Individual
Prefix:
First Name:BRACHA
Middle Name:
Last Name:SKAIST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5153
Mailing Address - Country:US
Mailing Address - Phone:732-237-6479
Mailing Address - Fax:
Practice Address - Street 1:90 PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5153
Practice Address - Country:US
Practice Address - Phone:732-237-6479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist