Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 22DI01776100 | NJ |
Y | 213EG0000X | General Practice | 22DI01776100 | NJ |
NPI | 1003016833 |
---|---|
Provider Name | Dr. Laura Ann Randolph |
First Address | Ramsey, NJ 07446-1609 |
Second Address | Ramsey, NJ 07446-1609 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2007 |
Last Update Date | 19/07/2007 |