Healthcare Provider Details

I. General information

NPI: 1093215501
Provider Name (Legal Business Name): BROOKE MIZRAHI SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 02/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 CRAIG RD
HILLSDALE NJ
07642-1003
US

IV. Provider business mailing address

25 CRAIG RD
HILLSDALE NJ
07642-1003
US

V. Phone/Fax

Practice location:
  • Phone: 516-425-1307
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS00579900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: