Provider Demographics
NPI:1659547735
Name:ENGLEWOOD SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:ENGLEWOOD SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH/LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FISHBEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSPA
Authorized Official - Phone:201-286-5138
Mailing Address - Street 1:75 SHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2734
Mailing Address - Country:US
Mailing Address - Phone:201-286-5138
Mailing Address - Fax:201-569-6709
Practice Address - Street 1:163 ENGLE ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2535
Practice Address - Country:US
Practice Address - Phone:201-286-5138
Practice Address - Fax:201-569-6709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00206100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1649342965OtherNPI INDIVIDUAL