Provider Demographics
NPI:1568672913
Name:MIDSTATE THERAPY ASSOCIATES LLC
Entity Type:Organization
Organization Name:MIDSTATE THERAPY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MERRILL
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:STAUBER
Authorized Official - Suffix:
Authorized Official - Credentials:MACCC-SLP
Authorized Official - Phone:732-431-5093
Mailing Address - Street 1:219 TAYLOR MILLS RD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3255
Mailing Address - Country:US
Mailing Address - Phone:732-431-5093
Mailing Address - Fax:732-431-5094
Practice Address - Street 1:219 TAYLOR MILLS RD
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3255
Practice Address - Country:US
Practice Address - Phone:732-431-5093
Practice Address - Fax:732-431-5094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00180400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty