MEDICARE: CHRISTINA MYERJACK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1366918351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA MYERJACK

Provider Business Mailing Address
First Line	:	34 KINGSLAND RD
Second Line	:
City	:	HEWITT
State	:	NJ
Zip	:	07421-1519
Country	:	US
Telephone Number	:	201-906-6353
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 DWIGHT PL
Second Line	:
City	:	FAIRFIELD
State	:	NJ
Zip	:	07004-3304
Country	:	US
Telephone Number	:	973-882-8822
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2018
Last Update Date	:	08/14/2022

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Directions to “ CHRISTINA MYERJACK ” Practice Location

Language	Start Address	Practice Location

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