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General NPI Number Information
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NPI Number | 1609333426
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Entity Type | Individual
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Provider Name | DIANA AIDA SCALICI
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Gender | Female
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Dates
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Enumeration Date | 02/28/2019
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Last Update Date | 02/28/2019
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Provider Practice Location Address
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Address Line | 120 COUNTY RD STE 101
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City | TENAFLY
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State | NJ
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Zip | 07670-1854
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Country | US
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Telephone | 201-894-5800
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Fax |
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Provider Business Mailing Address
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Address Line | 407 MEMORIAL PKWY
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City | BLOOMFIELD
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State | NJ
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Zip | 07003-4266
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Country | US
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Telephone | 908-907-1940
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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 | 41YS00904000
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License Number State | NJ
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