Provider Demographics
NPI:1902575764
Name:SPEECH THERAPY GROUP
Entity Type:Organization
Organization Name:SPEECH THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALQUDAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-945-4545
Mailing Address - Street 1:239 BERGEN BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:07022-1323
Mailing Address - Country:US
Mailing Address - Phone:201-945-4545
Mailing Address - Fax:
Practice Address - Street 1:239 BERGEN BLVD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:NJ
Practice Address - Zip Code:07022-1323
Practice Address - Country:US
Practice Address - Phone:201-945-4545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyGroup - Single Specialty