Provider Demographics
NPI:1245065358
Name:ABUTAYEB, AMINAH MOHAMMAD (SPEECH THERAPY)
Entity type:Individual
Prefix:
First Name:AMINAH
Middle Name:MOHAMMAD
Last Name:ABUTAYEB
Suffix:
Gender:F
Credentials:SPEECH THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PROSPECT PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2235
Mailing Address - Country:US
Mailing Address - Phone:973-953-9999
Mailing Address - Fax:
Practice Address - Street 1:227 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-4011
Practice Address - Country:US
Practice Address - Phone:973-796-6954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTL-4322235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty