Provider Demographics
NPI:1497109771
Name:ITURBURO, AMY KARLYNA (BD)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:KARLYNA
Last Name:ITURBURO
Suffix:
Gender:F
Credentials:BD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-1518
Mailing Address - Country:US
Mailing Address - Phone:973-494-2681
Mailing Address - Fax:
Practice Address - Street 1:452 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-1518
Practice Address - Country:US
Practice Address - Phone:973-494-2681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJI84160407253932174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist