Provider Demographics
NPI:1295070332
Name:HOLZBERG, SHARA (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHARA
Middle Name:
Last Name:HOLZBERG
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MEADOWLANDS PKWY
Mailing Address - Street 2:MHMC; DEPARTMENT OF NCR - 2ND FLOOR
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-2977
Mailing Address - Country:US
Mailing Address - Phone:201-392-3100
Mailing Address - Fax:201-271-3688
Practice Address - Street 1:55 MEADOWLANDS PKWY
Practice Address - Street 2:MHMC; DEPARTMENT OF NCR - 2ND FLOOR
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2977
Practice Address - Country:US
Practice Address - Phone:201-392-3100
Practice Address - Fax:201-271-3688
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS665600235Z00000X
NY02188235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist