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General NPI Number Information
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NPI Number | 1740647528
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Entity Type | Organization
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Legal Business Name | GARDEN STATE SPEECH THERAPY
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Dates
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Enumeration Date | 01/25/2016
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Last Update Date | 10/02/2018
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Provider Practice Location Address
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Address Line | 223 OLD HOOK RD
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City | WESTWOOD
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State | NJ
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Zip | 07675
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Country | US
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Telephone | 201-603-2277
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Fax | 201-829-0817
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Provider Business Mailing Address
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Address Line | 558 ANDERSON AVE APT 2A
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City | CLIFFSIDE PARK
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State | NJ
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Zip | 07010-1704
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Country | US
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Telephone | 201-965-9695
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Fax | 201-829-0817
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Authorized Official
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Title or Position | CO-OWNER
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Name | MS. PAULA KORIK
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Credential |
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Telephone | 201-603-2277
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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 | 41YS00603400
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License Number State | NJ
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