Provider Demographics
NPI:1154727436
Name:FIVE STAR LEARNING PC
Entity type:Organization
Organization Name:FIVE STAR LEARNING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHN
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:646-483-2127
Mailing Address - Street 1:108 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2551
Mailing Address - Country:US
Mailing Address - Phone:646-483-2127
Mailing Address - Fax:
Practice Address - Street 1:108 FOREST AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-2551
Practice Address - Country:US
Practice Address - Phone:646-483-2127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00479100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty