Healthcare Provider Details

I. General information

NPI: 1598259848
Provider Name (Legal Business Name): DYNAMIC SPECIALTIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 PRINCETON AVE
LAKEWOOD NJ
08701-2883
US

IV. Provider business mailing address

618 PRINCETON AVE
LAKEWOOD NJ
08701-2883
US

V. Phone/Fax

Practice location:
  • Phone: 323-434-8222
  • Fax: 732-806-8376
Mailing address:
  • Phone: 323-434-8222
  • Fax: 732-806-8376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: TEHILA LAUFER
Title or Position: OWNER
Credential: M.S. CCC-SLP
Phone: 323-434-8222