Provider Demographics
NPI:1225663271
Name:BERTOS, FANI F (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:FANI
Middle Name:F
Last Name:BERTOS
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 1:321 NORTH AVE E UNIT 125
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2468
Mailing Address - Country:US
Mailing Address - Phone:609-471-3747
Mailing Address - Fax:
Practice Address - Street 1:945 RIVER AVE STE 201
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5675
Practice Address - Country:US
Practice Address - Phone:732-833-3723
Practice Address - Fax:888-247-4390
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01010600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist