Provider Demographics
NPI:1720670136
Name:MACATANGAY, AMARIAH ELLICE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMARIAH ELLICE
Middle Name:
Last Name:MACATANGAY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 RIVERFRONT BLVD APT 312
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-1041
Mailing Address - Country:US
Mailing Address - Phone:201-543-8122
Mailing Address - Fax:
Practice Address - Street 1:2854 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4014
Practice Address - Country:US
Practice Address - Phone:201-792-2582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01064500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist