=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902597594
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOHAR SPEECH THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2023
-----------------------------------------------------
Last Update Date | 05/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 579 CRANBURY RD STE I
-----------------------------------------------------
City | EAST BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08816-5405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-313-5458
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 579 CRANBURY RD
-----------------------------------------------------
City | EAST BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08816-5405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-313-5458
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | MS. SANAH TARIQ GOHAR
-----------------------------------------------------
Credential | MS CCC
-----------------------------------------------------
Telephone | 732-406-8206
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------