Active NPI
Carmen Polise, MA
- Speech-Language Pathologist
- Chatham, NJ
National Provider Identifier
1679115174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 41YS00360100
- Practice address
- 667 Shunpike Rd
Chatham, NJ 07928-1574 - Phone
- (973) 229-6456
- NPI assigned
- Oct 16, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 41YS00360100 | NJ | Primary |
Addresses
Primary practice location
667 Shunpike Rd
Chatham, NJ 07928-1574
Mailing address
301 W 53Rd St
New York, NY 10019-5766
Phone (973) 229-6456
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41YS00360100 | NJ | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571184000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736121600000",
"number": "1679115174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 W 53RD ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100195766",
"telephone_number": "973-229-6456"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "667 SHUNPIKE RD",
"city": "CHATHAM",
"state": "NJ",
"postal_code": "079281574",
"telephone_number": "973-229-6456"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLISE",
"first_name": "CARMEN",
"credential": "MA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-10-16",
"last_updated": "2025-01-06",
"certification_date": "2025-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NJ",
"license": "41YS00360100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chatham, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.