Active NPI
Chaya Wydra
- Speech-Language Pathologist
- Lakewood, NJ
National Provider Identifier
1972934032
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 41YS00683500
- Practice address
- 809 River Ave Ste 4
Lakewood, NJ 08701-5286 - Phone
- (732) 534-6707
- Fax
- (732) 730-5968
- NPI assigned
- Nov 27, 2013
- 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 | 41YS00683500 | NJ | Primary |
Addresses
Primary practice location
809 River Ave Ste 4
Lakewood, NJ 08701-5286
Mailing address
36 High St
Lakewood, NJ 08701-5223
Phone (732) 804-6011
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41YS00683500 | NJ | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1385510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1385510400000",
"number": "1972934032",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "36 HIGH ST",
"city": "LAKEWOOD",
"state": "NJ",
"postal_code": "087015223",
"telephone_number": "732-804-6011",
"fax_number": "732-730-5968"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "809 RIVER AVE STE 4",
"city": "LAKEWOOD",
"state": "NJ",
"postal_code": "087015286",
"telephone_number": "732-534-6707",
"fax_number": "732-730-5968"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYDRA",
"first_name": "CHAYA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-11-27",
"last_updated": "2013-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NJ",
"license": "41YS00683500",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.