Healthcare Provider Details

I. General information

NPI: 1417028705
Provider Name (Legal Business Name): AMY BERNSTEIN MA CCC SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W MAIN ST STE 4
FREEHOLD NJ
07728-2523
US

IV. Provider business mailing address

900 W MAIN ST SUITE 4
FREEHOLD NJ
07728-2523
US

V. Phone/Fax

Practice location:
  • Phone: 732-431-3602
  • Fax: 732-431-3603
Mailing address:
  • Phone: 732-431-3602
  • Fax: 732-431-3603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS00387300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: