Provider Demographics
NPI:1215974902
Name:LAUB, EDWARD B (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:B
Last Name:LAUB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2055 KLOCKNER RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3413
Mailing Address - Country:US
Mailing Address - Phone:609-586-8060
Mailing Address - Fax:609-586-7470
Practice Address - Street 1:2055 KLOCKNER RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3413
Practice Address - Country:US
Practice Address - Phone:609-586-8060
Practice Address - Fax:609-586-7470
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA03570600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC56912Medicare UPIN
NJ527699L5EMedicare ID - Type Unspecified