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General NPI Number Information
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NPI Number | 1275005852
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Entity Type | Organization
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Legal Business Name | AUDSLP DIAGNOSTIC AND REHABILITATION CLINIC
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Dates
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Enumeration Date | 12/20/2018
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Last Update Date | 06/04/2022
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Provider Practice Location Address
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Address Line | 1 BROADWAY STE 302
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City | ELMWOOD PARK
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State | NJ
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Zip | 07407-1845
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Country | US
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Telephone | 201-773-8962
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Fax | 201-773-8963
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Provider Business Mailing Address
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Address Line | 1 BROADWAY STE 302
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City | ELMWOOD PARK
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State | NJ
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Zip | 07407-1845
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Country | US
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Telephone | 201-773-8962
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Fax | 201-773-8963
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | NORMA IRIS CARBAJAL
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Credential |
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Telephone | 551-202-4929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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