1245035054 NPI number — REBECCA KORNFELD M.A., CCC-SLP

NPI Number: 1245035054
Health Care Provider/Practitioner: REBECCA KORNFELD M.A., CCC-SLP

NPI Number : 1245035054 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1245035054",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KORNFELD",
    "FirstName": "REBECCA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.A., CCC-SLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1500 SAINT GEORGES AVE STE F",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "AVENEL",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "07001-1000",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "732-860-9003",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1500 SAINT GEORGES AVE STE F",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "AVENEL",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "07001-1000",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "732-860-9003",
    "PracticeLocationAddressFaxNumber": "732-231-5023",
    "EnumerationDate": "02/17/2025",
    "LastUpdateDate": "03/03/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "235Z00000X",
        "TaxonomyName": "Speech-Language Pathologist",
        "LicenseNumber": "41YS01154400",
        "LicenseNumberStateCode": "NJ",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}