Provider Demographics
NPI:1477300481
Name:ATAR, ADI ELIZABETH
Entity type:Individual
Prefix:
First Name:ADI
Middle Name:ELIZABETH
Last Name:ATAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADI
Other - Middle Name:ELIZABETH
Other - Last Name:ANAPOLLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1321 E POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-4807
Mailing Address - Country:US
Mailing Address - Phone:732-485-2754
Mailing Address - Fax:
Practice Address - Street 1:581 NORTHUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-1908
Practice Address - Country:US
Practice Address - Phone:732-485-2754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSLP-2023-0256235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist