Provider Demographics
NPI:1992534317
Name:ALBURTUS, ANTONIA AMANDA (SLP)
Entity type:Individual
Prefix:MISS
First Name:ANTONIA
Middle Name:AMANDA
Last Name:ALBURTUS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-2503
Mailing Address - Country:US
Mailing Address - Phone:201-779-6955
Mailing Address - Fax:
Practice Address - Street 1:37 W 9TH ST
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-2503
Practice Address - Country:US
Practice Address - Phone:201-779-6955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01231100235Z00000X
NY030321235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist