Provider Demographics
NPI:1538795786
Name:ALBANESE, ANTHONY G (BC-HIS)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:G
Last Name:ALBANESE
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 ROUTE 46 W
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-1589
Mailing Address - Country:US
Mailing Address - Phone:973-818-2025
Mailing Address - Fax:
Practice Address - Street 1:653 ROUTE 46 W
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-1589
Practice Address - Country:US
Practice Address - Phone:973-818-2025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000028100237700000X
NJ1136237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist