Provider Demographics
NPI:1689122046
Name:KROEN, CHAYA MIRIAM
Entity Type:Individual
Prefix:
First Name:CHAYA
Middle Name:MIRIAM
Last Name:KROEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:C
Other - Last Name:ILOWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, SLP
Mailing Address - Street 1:5616 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-1834
Mailing Address - Country:US
Mailing Address - Phone:718-687-8662
Mailing Address - Fax:
Practice Address - Street 1:5616 17TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-1834
Practice Address - Country:US
Practice Address - Phone:718-687-8662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1689122046Medicaid