Provider Demographics
NPI:1740647528
Name:GARDEN STATE SPEECH THERAPY
Entity type:Organization
Organization Name:GARDEN STATE SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:KORIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-603-2277
Mailing Address - Street 1:558 ANDERSON AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1704
Mailing Address - Country:US
Mailing Address - Phone:201-965-9695
Mailing Address - Fax:201-829-0817
Practice Address - Street 1:223 OLD HOOK RD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675
Practice Address - Country:US
Practice Address - Phone:201-603-2277
Practice Address - Fax:201-829-0817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00603400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty