Provider Demographics
NPI:1699471631
Name:LEVYCHAIM, AYELET (MA)
Entity type:Individual
Prefix:
First Name:AYELET
Middle Name:
Last Name:LEVYCHAIM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:AYELET
Other - Middle Name:
Other - Last Name:MOINZADEH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:41 MAPLEWOOD TER
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2991
Mailing Address - Country:US
Mailing Address - Phone:443-991-9983
Mailing Address - Fax:
Practice Address - Street 1:41 MAPLEWOOD TER
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-2991
Practice Address - Country:US
Practice Address - Phone:443-991-9983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00924400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty