Healthcare Provider Details

I. General information

NPI: 1578852919
Provider Name (Legal Business Name): SHULAMIS S DEUTSCH MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 RIVER AVE
LAKEWOOD NJ
08701-5228
US

IV. Provider business mailing address

474 11TH ST APT C
LAKEWOOD NJ
08701-2634
US

V. Phone/Fax

Practice location:
  • Phone: 732-354-3772
  • Fax:
Mailing address:
  • Phone: 732-363-1066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTL1935
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: