Individual provider Active NPI

Jeanine Burdge, MACCC-SLP

  • Speech-Language Pathologist
  • Westfield, NJ
National Provider Identifier
1104054790
Registry record updated Jun 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
41YS00576800 Issued in NJ
Practice address
1515 Lamberts Mill Rd
Westfield, NJ 07090-4763
Phone
(908) 233-9700
NPI assigned
Jun 23, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 41YS00576800 NJ Primary

Addresses

Primary practice location

1515 Lamberts Mill Rd
Westfield, NJ 07090-4763

Mailing address

806 Shore Rd
Spring Lake, NJ 07762-1943
Phone (732) 449-6059

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
41YS00576800NJMDSpeech-Language Pathologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245715200000",
    "number": "1104054790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 SHORE RD",
            "city": "SPRING LAKE",
            "state": "NJ",
            "postal_code": "077621943",
            "telephone_number": "732-449-6059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 LAMBERTS MILL RD",
            "city": "WESTFIELD",
            "state": "NJ",
            "postal_code": "070904763",
            "telephone_number": "908-233-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURDGE",
        "first_name": "JEANINE",
        "credential": "MACCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-23",
        "last_updated": "2009-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NJ",
            "license": "41YS00576800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westfield, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.