Provider Demographics
NPI:1457726697
Name:BROIZMAN, ALISA DAWN (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:DAWN
Last Name:BROIZMAN
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:HAWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07641-1907
Mailing Address - Country:US
Mailing Address - Phone:201-281-4397
Mailing Address - Fax:
Practice Address - Street 1:37 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:HAWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07641-1907
Practice Address - Country:US
Practice Address - Phone:201-387-9293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-13
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00700000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist