Provider Demographics
NPI:1871371625
Name:IMMERSED THERAPIES
Entity type:Organization
Organization Name:IMMERSED THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAQUEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-564-0917
Mailing Address - Street 1:701 STATE RT 440 STE 440
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 STATE RT 440 STE 440
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1069
Practice Address - Country:US
Practice Address - Phone:718-564-0917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty