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General NPI Number Information
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NPI Number | 1689089047
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Entity Type | Organization
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Legal Business Name | SPEECH AT THE BEACH
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Dates
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Enumeration Date | 06/24/2014
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Last Update Date | 06/24/2014
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Provider Practice Location Address
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Address Line | 38 TAYLOR AVE
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City | MANASQUAN
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State | NJ
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Zip | 08736-3047
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Country | US
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Telephone | 732-455-5504
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Fax |
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Provider Business Mailing Address
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Address Line | 6 ASPEN CT
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City | OCEAN
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State | NJ
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Zip | 07712-3491
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SPEECH THERAPIST
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Name | PAMELA ADELE JONES
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Credential | MA CCC-SLP
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Telephone | 732-455-5504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 41YS00774600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 41YS00774600
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 41YS00774600
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 41YS00774600
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License Number State | NJ
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