Healthcare Provider Details

I. General information

NPI: 1083108005
Provider Name (Legal Business Name): PEREL PLUTCHOK MA, SLP, CF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 BRIDGEWOOD AVE
LAKEWOOD NJ
08701-4749
US

IV. Provider business mailing address

123 14TH ST
LAKEWOOD NJ
08701-1831
US

V. Phone/Fax

Practice location:
  • Phone: 732-730-7850
  • Fax:
Mailing address:
  • Phone: 347-277-6025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTL-3070
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: