Provider Demographics
NPI:1003991993
Name:DENENBERG, LARRY JAY (MA CCC A)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:JAY
Last Name:DENENBERG
Suffix:
Gender:M
Credentials:MA CCC A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 OLD YORK RD
Mailing Address - Street 2:STE 104
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046
Mailing Address - Country:US
Mailing Address - Phone:215-886-2268
Mailing Address - Fax:215-886-6016
Practice Address - Street 1:500 OLD YORK RD
Practice Address - Street 2:STE 104
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046
Practice Address - Country:US
Practice Address - Phone:215-886-2268
Practice Address - Fax:215-886-6016
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000357L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0928241OtherAETNA