Provider Demographics
NPI:1104300052
Name:JEREMIE HAFITZ, LLC
Entity type:Organization
Organization Name:JEREMIE HAFITZ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JEREMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAFITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPHIL, CCC
Authorized Official - Phone:973-743-6032
Mailing Address - Street 1:27 WILDWOOD TER
Mailing Address - Street 2:
Mailing Address - City:GLEN RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07028-2310
Mailing Address - Country:US
Mailing Address - Phone:973-743-6032
Mailing Address - Fax:973-276-9062
Practice Address - Street 1:27 WILDWOOD TER
Practice Address - Street 2:
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-2310
Practice Address - Country:US
Practice Address - Phone:973-743-6032
Practice Address - Fax:973-276-9062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ41YS00242100OtherSPEECH LANGUAGE PATHOLOGY LICENSE