Provider Demographics
NPI:1285268938
Name:GEORGETTE A. PRONESTI
Entity type:Organization
Organization Name:GEORGETTE A. PRONESTI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:GEORGETTE
Authorized Official - Middle Name:ADAMS
Authorized Official - Last Name:PRONESTI
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED, CCC-SLP
Authorized Official - Phone:845-853-3596
Mailing Address - Street 1:287 MOUNT PROSPECT AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-2064
Mailing Address - Country:US
Mailing Address - Phone:845-853-3596
Mailing Address - Fax:201-510-0297
Practice Address - Street 1:1299 HILLRIDGE DR SE
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:GA
Practice Address - Zip Code:31305-5770
Practice Address - Country:US
Practice Address - Phone:845-853-3596
Practice Address - Fax:201-510-0297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty