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General NPI Number Information
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NPI Number | 1467671594
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Entity Type | Organization
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Legal Business Name | CENTRAL JERSEY SPEECH,OCCUPATIONAL & PHYSICAL THERAPY
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 03/18/2008
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Provider Practice Location Address
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Address Line | 721 W KENNEDY BLVD
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City | LAKEWOOD
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State | NJ
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Zip | 08701-1255
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Country | US
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Telephone | 732-367-8577
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Fax |
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Provider Business Mailing Address
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Address Line | 1004 LEXINGTON AVE
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City | LAKEWOOD
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State | NJ
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Zip | 08701-1863
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Country | US
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Telephone | 732-367-6332
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Fax | 732-901-8452
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Authorized Official
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Title or Position | DIRECTOR
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Name | FAIGA DISKIND
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Credential | M.A., C.C.C.
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Telephone | 732-367-6332
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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 | 41YS00062200
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License Number State | NJ
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