Provider Demographics
NPI:1477020741
Name:ANGELLELLA, BROOKE T (HIS)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:T
Last Name:ANGELLELLA
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 TILTON RD STE 110
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1258
Mailing Address - Country:US
Mailing Address - Phone:609-641-1963
Mailing Address - Fax:609-641-8211
Practice Address - Street 1:450 TILTON RD STE 110
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1258
Practice Address - Country:US
Practice Address - Phone:609-641-1963
Practice Address - Fax:609-641-8211
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG00149400237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist