Provider Demographics
NPI:1538645528
Name:CERVINI, BRENDA E (HAD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:E
Last Name:CERVINI
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 ROUTE 46 STE G51
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1676
Mailing Address - Country:US
Mailing Address - Phone:973-588-7266
Mailing Address - Fax:973-588-7268
Practice Address - Street 1:1760 EMPIRE BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2179
Practice Address - Country:US
Practice Address - Phone:585-787-1385
Practice Address - Fax:585-787-1385
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14000039997OtherHAD LICENSE