Provider Demographics
NPI:1417028705
Name:BERNSTEIN, AMY (MA CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2523
Mailing Address - Country:US
Mailing Address - Phone:732-431-3602
Mailing Address - Fax:732-431-3603
Practice Address - Street 1:900 W MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2523
Practice Address - Country:US
Practice Address - Phone:732-431-3602
Practice Address - Fax:732-431-3603
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00387300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ41YS00387300OtherSPEECH PATHOLOGIST