Healthcare Provider Details

I. General information

NPI: 1255861183
Provider Name (Legal Business Name): KOURTNEY AGUGLIARO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 06/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 MADISON AVE
MORRISTOWN NJ
07960-6016
US

IV. Provider business mailing address

151 MADISON AVE
MORRISTOWN NJ
07960-6016
US

V. Phone/Fax

Practice location:
  • Phone: 973-656-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS00838000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: