Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 25MA10179000 | NJ |
Y | 2081P2900X | Pain Medicine | 25MA10179000 | NJ |
NPI | 1356684583 |
---|---|
Provider Name | Dr. Laurent Delavaux |
First Address | Edison, NJ 08820-3947 |
Second Address | Edison, NJ 08820 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2013 |
Last Update Date | 01/06/2018 |