Healthcare Provider Details

I. General information

NPI: 1487962452
Provider Name (Legal Business Name): MALKA B KUZNICKI M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1889 NEW CENTRAL AVENUE
LAKEWOOD NJ
08701
US

IV. Provider business mailing address

1889 NEW CENTRAL AVE
LAKEWOOD NJ
08701-2922
US

V. Phone/Fax

Practice location:
  • Phone: 732-370-9986
  • Fax:
Mailing address:
  • Phone: 732-370-9986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS00563900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: