Provider Demographics
NPI:1023353000
Name:CANNATA-STANLICK, PEGGY J (NJ HEARING AID DISPE)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:J
Last Name:CANNATA-STANLICK
Suffix:
Gender:F
Credentials:NJ HEARING AID DISPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-4713
Mailing Address - Country:US
Mailing Address - Phone:201-343-1980
Mailing Address - Fax:201-343-6323
Practice Address - Street 1:681 MAIN ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-4713
Practice Address - Country:US
Practice Address - Phone:201-343-1980
Practice Address - Fax:201-343-6323
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG00108600237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist