=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346678109
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEINMAN SPEECH LANGUAGE PATHOLOGY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2013
-----------------------------------------------------
Last Update Date | 10/14/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45 LEIGH DR
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08701-2917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-850-8435
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45 LEIGH DR
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08701-2917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-961-9590
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | MRS. MALKA WEINMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-961-9590
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 41YS00467300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------