Provider Demographics
NPI:1609136522
Name:GINSBERG, TAMAR S (CCC SLP)
Entity Type:Individual
Prefix:
First Name:TAMAR
Middle Name:S
Last Name:GINSBERG
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-2804
Mailing Address - Country:US
Mailing Address - Phone:201-384-1859
Mailing Address - Fax:
Practice Address - Street 1:204 W BROAD ST
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-2804
Practice Address - Country:US
Practice Address - Phone:201-384-1859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019462235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist