Provider Demographics
NPI:1568884674
Name:FISHMAN, BROCHA
Entity Type:Individual
Prefix:
First Name:BROCHA
Middle Name:
Last Name:FISHMAN
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 1:44 CHARMING WAY
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5450
Mailing Address - Country:US
Mailing Address - Phone:848-525-5081
Mailing Address - Fax:732-994-5878
Practice Address - Street 1:44 CHARMING WAY
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5450
Practice Address - Country:US
Practice Address - Phone:848-525-5081
Practice Address - Fax:732-994-5878
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00707200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist