Healthcare Provider Details

I. General information

NPI: 1114417680
Provider Name (Legal Business Name): SAMANTHA ELIZABETH ELIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 RIVER AVE
LAKEWOOD NJ
08701-5288
US

IV. Provider business mailing address

59 KIRK LN
MEDIA PA
19063-2138
US

V. Phone/Fax

Practice location:
  • Phone: 732-367-3667
  • Fax:
Mailing address:
  • Phone: 732-668-6560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: