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General NPI Number Information
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NPI Number | 1336592963
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Entity Type | Individual
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Provider Name | SIMONE JERONIMO
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Gender | Female
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Dates
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Enumeration Date | 07/19/2016
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Last Update Date | 07/19/2016
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Provider Practice Location Address
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Address Line | 4 RAILROAD AVE
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City | SOMERSET
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State | NJ
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Zip | 08873-2724
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Country | US
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Telephone | 732-873-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 80 DAWN DR
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City | CLARK
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State | NJ
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Zip | 07066-1435
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Country | US
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Telephone | 732-397-5866
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 41YS00857300
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License Number State | NJ
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