Provider Demographics
NPI:1982196390
Name:EL ON KOREN, EILA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EILA
Middle Name:
Last Name:EL ON KOREN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 TENAFLY RD
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2530
Mailing Address - Country:US
Mailing Address - Phone:201-660-2201
Mailing Address - Fax:
Practice Address - Street 1:280 TENAFLY RD
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2530
Practice Address - Country:US
Practice Address - Phone:201-660-2201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00947500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist