Healthcare Provider Details

I. General information

NPI: 1396413563
Provider Name (Legal Business Name): ROBIN ZICHERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40A GARDEN OF EDEN DR
LAKEWOOD NJ
08701-4168
US

IV. Provider business mailing address

40A GARDEN OF EDEN DR
LAKEWOOD NJ
08701-4168
US

V. Phone/Fax

Practice location:
  • Phone: 917-863-0008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS01036700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: