Provider Demographics
NPI:1881884237
Name:BRANCO, MAURA COSTA
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:COSTA
Last Name:BRANCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAURA
Other - Middle Name:COSTA
Other - Last Name:BRANCO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:295A FERRY ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-3443
Mailing Address - Country:US
Mailing Address - Phone:973-589-8341
Mailing Address - Fax:
Practice Address - Street 1:295A FERRY ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-3443
Practice Address - Country:US
Practice Address - Phone:973-589-8341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG00111200237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8125503Medicaid