Provider Demographics
NPI:1851706550
Name:DEMBNER, ELISSA
Entity Type:Individual
Prefix:MRS
First Name:ELISSA
Middle Name:
Last Name:DEMBNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MACKENZIE TER
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1612
Mailing Address - Country:US
Mailing Address - Phone:732-616-4695
Mailing Address - Fax:732-536-1113
Practice Address - Street 1:7 MACKENZIE TER
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1612
Practice Address - Country:US
Practice Address - Phone:732-616-4695
Practice Address - Fax:732-536-1113
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00083400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist