Provider Demographics
NPI:1548444235
Name:LAURENTE MEDICAL ASSOCIATES, P.A.
Entity type:Organization
Organization Name:LAURENTE MEDICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROMEO
Authorized Official - Middle Name:
Authorized Official - Last Name:LAURENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-587-0119
Mailing Address - Street 1:4453 NOTTINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:HAMILTON SQUARE
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3815
Mailing Address - Country:US
Mailing Address - Phone:609-587-0119
Mailing Address - Fax:609-587-3009
Practice Address - Street 1:4453 NOTTINGHAM WAY
Practice Address - Street 2:
Practice Address - City:HAMILTON SQUARE
Practice Address - State:NJ
Practice Address - Zip Code:08690-3815
Practice Address - Country:US
Practice Address - Phone:609-587-0119
Practice Address - Fax:609-587-3009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23982207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4721705Medicaid
NJB20493Medicare UPIN
NJ4721705Medicaid