Provider Demographics
NPI:1700384823
Name:DITTELMAN, JANICE (MASTER OF SCIENCE)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:DITTELMAN
Suffix:
Gender:F
Credentials:MASTER OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 VICTOR WAY
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1807
Mailing Address - Country:US
Mailing Address - Phone:201-560-1235
Mailing Address - Fax:
Practice Address - Street 1:1515 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3002
Practice Address - Country:US
Practice Address - Phone:973-655-7752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00403600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist