Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 22DI02107800 | NJ |
Y | 213EG0000X | General Practice | 22DI02107800 | NJ |
NPI | 1992997696 |
---|---|
Provider Name | Dr. Lara Elizabeth Hartleben |
First Address | Ship Bottom, NJ 08008-4686 |
Second Address | Ship Bottom, NJ 08008-4444 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2007 |
Last Update Date | 16/08/2007 |