Provider Demographics
NPI:1518318799
Name:IVORY THERAPY GROUP INC
Entity Type:Organization
Organization Name:IVORY THERAPY GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENZION
Authorized Official - Middle Name:
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:732-655-8255
Mailing Address - Street 1:1469 CEDARVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1720
Mailing Address - Country:US
Mailing Address - Phone:732-655-8255
Mailing Address - Fax:212-776-0798
Practice Address - Street 1:1469 CEDARVIEW AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-1720
Practice Address - Country:US
Practice Address - Phone:732-655-8255
Practice Address - Fax:212-776-0798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty