Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 38MC00714000 | NJ |
N | 111NN1001X | Nutrition | 38MC00714000 | NJ |
NPI | 1295158202 |
---|---|
Provider Name | Laura Decesaris |
First Address | Florham Park, NJ 07932-1411 |
Second Address | Florham Park, NJ 07932-1411 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2014 |
Last Update Date | 27/01/2014 |