Provider Demographics
NPI:1609180447
Name:REICH, BENJAMIN (SLP)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:REICH
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1992
Mailing Address - Country:US
Mailing Address - Phone:732-905-4409
Mailing Address - Fax:
Practice Address - Street 1:32 E 9TH ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-1992
Practice Address - Country:US
Practice Address - Phone:732-966-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00639600235Z00000X
NY019548235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist