Provider Demographics
NPI:1265769038
Name:STEIN, BAILA C
Entity type:Individual
Prefix:
First Name:BAILA
Middle Name:C
Last Name:STEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BAILA
Other - Middle Name:C
Other - Last Name:NUSSBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:182 MARION CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4647
Mailing Address - Country:US
Mailing Address - Phone:732-363-3297
Mailing Address - Fax:
Practice Address - Street 1:182 MARION CT
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4647
Practice Address - Country:US
Practice Address - Phone:732-363-3297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-15
Last Update Date:2009-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00534100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist