Provider Demographics
NPI:1578624177
Name:MSB THERAPY, LLC
Entity Type:Organization
Organization Name:MSB THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF SLP
Authorized Official - Prefix:MS
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZAAR
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP, HPCS
Authorized Official - Phone:201-306-9818
Mailing Address - Street 1:55 SKYLINE DRIVE
Mailing Address - Street 2:SUITE 206A
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456
Mailing Address - Country:US
Mailing Address - Phone:201-306-9818
Mailing Address - Fax:
Practice Address - Street 1:55 SKYLINE DRIVE
Practice Address - Street 2:SUITE 206A
Practice Address - City:RINGWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07456
Practice Address - Country:US
Practice Address - Phone:201-306-9818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00374600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty