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General NPI Number Information
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NPI Number | 1366918351
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Entity Type | Individual
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Provider Name | CHRISTINA MYERJACK
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Gender | Female
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Dates
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Enumeration Date | 10/17/2018
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Last Update Date | 08/14/2022
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Provider Practice Location Address
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Address Line | 28 DWIGHT PL
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City | FAIRFIELD
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State | NJ
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Zip | 07004-3304
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Country | US
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Telephone | 973-882-8822
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Fax |
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Provider Business Mailing Address
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Address Line | 34 KINGSLAND RD
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City | HEWITT
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State | NJ
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Zip | 07421-1519
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Country | US
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Telephone | 201-906-6353
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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