Provider Demographics
NPI:1689039216
Name:CHARLINE VEYTSMAN MA CCC-SLP
Entity Type:Organization
Organization Name:CHARLINE VEYTSMAN MA CCC-SLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VEYTSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:917-693-2172
Mailing Address - Street 1:2 JUDITH DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2109
Mailing Address - Country:US
Mailing Address - Phone:917-693-2172
Mailing Address - Fax:
Practice Address - Street 1:2 JUDITH DR
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2109
Practice Address - Country:US
Practice Address - Phone:917-693-2172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-26
Last Update Date:2015-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00485000252Y00000X
NY012241-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency