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General NPI Number Information
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NPI Number | 1396157558
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Entity Type | Individual
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Provider Name | AVIVA CZERMAK
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Gender | Female
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Dates
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Enumeration Date | 05/22/2014
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 930 E COUNTY LINE RD STE 4
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City | LAKEWOOD
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State | NJ
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Zip | 08701-2031
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Country | US
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Telephone | 732-276-6465
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Fax | 732-719-6892
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Provider Business Mailing Address
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Address Line | 24 CUSHMAN ST
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5201
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Country | US
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Telephone | 732-276-6465
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Fax | 732-719-6892
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 41YS00772000
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License Number State | NJ
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