Provider Demographics
NPI:1114260395
Name:FURIA, SANDRA J (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:FURIA
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 MAIN ST APT 24
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-2356
Mailing Address - Country:US
Mailing Address - Phone:201-396-9449
Mailing Address - Fax:
Practice Address - Street 1:271 ROUTE 46 W # 110
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-2440
Practice Address - Country:US
Practice Address - Phone:201-396-9449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00382200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ651241650OtherTIN