Healthcare Provider Details

I. General information

NPI: 1659547735
Provider Name (Legal Business Name): ENGLEWOOD SPEECH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 ENGLE ST SUITE 1B
ENGLEWOOD NJ
07631-2535
US

IV. Provider business mailing address

75 SHERWOOD RD
TENAFLY NJ
07670-2734
US

V. Phone/Fax

Practice location:
  • Phone: 201-286-5138
  • Fax: 201-569-6709
Mailing address:
  • Phone: 201-286-5138
  • Fax: 201-569-6709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS00206100
License Number StateNJ

VIII. Authorized Official

Name: CARLA ANN FISHBEIN
Title or Position: SPEECH/LANGUAGE PATHOLOGIST
Credential: M.S.P.A.
Phone: 201-286-5138