Provider Demographics
NPI:1598982894
Name:GARTENBERG, IRA LANCE (MS)
Entity Type:Individual
Prefix:MR
First Name:IRA
Middle Name:LANCE
Last Name:GARTENBERG
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 N TAMENEND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-5158
Mailing Address - Country:US
Mailing Address - Phone:215-489-0292
Mailing Address - Fax:
Practice Address - Street 1:270 N TAMENEND AVE
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:PA
Practice Address - Zip Code:18901-5158
Practice Address - Country:US
Practice Address - Phone:215-489-0292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL006241L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist