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General NPI Number Information
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NPI Number | 1659547735
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Entity Type | Organization
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Legal Business Name | ENGLEWOOD SPEECH THERAPY LLC
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 05/07/2008
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Provider Practice Location Address
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Address Line | 163 ENGLE ST SUITE 1B
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-2535
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Country | US
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Telephone | 201-286-5138
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Fax | 201-569-6709
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Provider Business Mailing Address
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Address Line | 75 SHERWOOD RD
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City | TENAFLY
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State | NJ
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Zip | 07670-2734
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Country | US
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Telephone | 201-286-5138
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Fax | 201-569-6709
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Authorized Official
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Title or Position | SPEECH/LANGUAGE PATHOLOGIST
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Name | CARLA ANN FISHBEIN
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Credential | M.S.P.A.
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Telephone | 201-286-5138
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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 | 41YS00206100
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License Number State | NJ
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