=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295499127
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH MARY STANKIEWICZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2021
-----------------------------------------------------
Last Update Date | 10/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 INTERCHANGE PLZ
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08831-2038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-617-1500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 340 SEQUOIA CT
-----------------------------------------------------
City | HOWELL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07731-3420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-995-3210
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 41YS00960200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------