Provider Demographics
NPI:1154133544
Name:MAGUETA, BRIAN ELCIO (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:ELCIO
Last Name:MAGUETA
Suffix:
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 CHERYL DR
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-3134
Mailing Address - Country:US
Mailing Address - Phone:732-570-5298
Mailing Address - Fax:
Practice Address - Street 1:500 CHARLES ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3352
Practice Address - Country:US
Practice Address - Phone:732-376-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ01851422235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist