MEDICARE: MRS. GITTIE SOFER M.S., SLS

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	41YS00784100	NJ

General Provider Information

NPI Number	:	1336542679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GITTIE SOFER M.S., SLS

Provider Business Mailing Address
First Line	:	137 E 4TH ST
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-3402
Country	:	US
Telephone Number	:	732-363-2154
Fax Number	:

Provider Business Practice Location Address
First Line	:	137 E 4TH ST
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-3402
Country	:	US
Telephone Number	:	732-363-2154
Fax Number	:

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

Provider Enumeration Date	:	10/01/2014
Last Update Date	:	10/01/2014

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