Provider Demographics
NPI:1326226952
Name:FONTANELLA, RENEE NANCY (MA CCCA)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:NANCY
Last Name:FONTANELLA
Suffix:
Gender:F
Credentials:MA CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3 PLAZA DRIVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-3759
Mailing Address - Country:US
Mailing Address - Phone:732-349-9515
Mailing Address - Fax:732-349-8803
Practice Address - Street 1:3 PLAZA DRIVE
Practice Address - Street 2:SUITE 8
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757-3759
Practice Address - Country:US
Practice Address - Phone:732-349-9515
Practice Address - Fax:732-349-8803
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00045300231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ052352QGSMedicare PIN