Provider Demographics
NPI:1932542255
Name:ELTSUFIN, MASHA (MA, SLP-CCC)
Entity type:Individual
Prefix:
First Name:MASHA
Middle Name:
Last Name:ELTSUFIN
Suffix:
Gender:F
Credentials:MA, SLP-CCC
Other - Prefix:
Other - First Name:MASHA
Other - Middle Name:
Other - Last Name:ANCHIPOLOVSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, SLP-CCC
Mailing Address - Street 1:226 MONROE ST APT 2RS
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6670
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:226 MONROE ST APT 2RS
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-6670
Practice Address - Country:US
Practice Address - Phone:201-835-4530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00720100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist