=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275602336
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEAMHOPE, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2006
-----------------------------------------------------
Last Update Date | 11/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 MORRISTOWN RD ROUTE 202
-----------------------------------------------------
City | BERNARDSVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07924-2328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-766-1717
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 115 MORRISTOWN RD ROUTE 202
-----------------------------------------------------
City | BERNARDSVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07924-2328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-766-1717
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OWNER
-----------------------------------------------------
Name | MS. HOPE IRENE FERNICOLA
-----------------------------------------------------
Credential | MA CCC SLP
-----------------------------------------------------
Telephone | 908-766-1717
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 41YS00402200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------