Provider Demographics
NPI:1205258217
Name:BUKH, ALLA MOLDAVSKY (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALLA
Middle Name:MOLDAVSKY
Last Name:BUKH
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SOUTH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7200
Mailing Address - Country:US
Mailing Address - Phone:908-578-6216
Mailing Address - Fax:
Practice Address - Street 1:31 SOUTH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7200
Practice Address - Country:US
Practice Address - Phone:908-578-6216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00431500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist