Provider Demographics
NPI:1720579915
Name:SPEECH AND READING ACADEMY, LLC
Entity Type:Organization
Organization Name:SPEECH AND READING ACADEMY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARBASH
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:732-698-8766
Mailing Address - Street 1:8 OLD BRIDGE TPKE
Mailing Address - Street 2:
Mailing Address - City:SOUTH RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08882-2400
Mailing Address - Country:US
Mailing Address - Phone:732-698-8766
Mailing Address - Fax:
Practice Address - Street 1:8 OLD BRIDGE TPKE
Practice Address - Street 2:
Practice Address - City:SOUTH RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08882-2400
Practice Address - Country:US
Practice Address - Phone:732-698-8766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00651500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1447543756OtherHORIZON BLUE CROSS BLUE SHIELD