Provider Demographics
NPI:1336580497
Name:WACHSSTOCK, CHAYA
Entity Type:Individual
Prefix:
First Name:CHAYA
Middle Name:
Last Name:WACHSSTOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-2419
Mailing Address - Country:US
Mailing Address - Phone:845-625-2810
Mailing Address - Fax:
Practice Address - Street 1:23 ROBERT PITT DR
Practice Address - Street 2:SUITE 110
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-3373
Practice Address - Country:US
Practice Address - Phone:845-625-2810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019999235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist