MEDICARE: LEBA R KATZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	41YS00644600	NJ

General Provider Information

NPI Number	:	1255602231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEBA R KATZ

Provider Business Mailing Address
First Line	:	9 KEDMA DR
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-3599
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1476 TOWERS ST
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5447
Country	:	US
Telephone Number	:	732-730-1190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2012
Last Update Date	:	01/23/2012

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Directions to “ LEBA R KATZ ” Practice Location

Language	Start Address	Practice Location

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