=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568776706
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALANA OBUHOVS M.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2010
-----------------------------------------------------
Last Update Date | 09/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 PINE ST
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08701-4963
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-534-7325
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 MONTANA DR
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08527-2116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-367-7249
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 016318
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------