Healthcare Provider Details

I. General information

NPI: 1821908922
Provider Name (Legal Business Name): GEORGINA L PECORARO MA CCC SLP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 OAKLAND MILLS RD
MANALAPAN NJ
07726-8600
US

IV. Provider business mailing address

82 OAKLAND MILLS RD
MANALAPAN NJ
07726-8600
US

V. Phone/Fax

Practice location:
  • Phone: 646-236-9099
  • Fax: 732-409-7256
Mailing address:
  • Phone: 646-236-9099
  • Fax: 732-409-7256

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: MRS. GEORGINA LOLLY PECORARO
Title or Position: SPEECH PATHOLOGIST
Credential: MA CCC SLP
Phone: 646-236-9099