MEDICARE: DR. LAURA PADHAM -VISITING AUDIOLOGIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355A2700X	Audiology Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1891157715	OTHER	NJ	PERSONAL NPI

General Provider Information

NPI Number	:	1598323701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. LAURA PADHAM -VISITING AUDIOLOGIST

Provider Business Mailing Address
First Line	:	PO BOX 23
Second Line	:
City	:	OCEAN GATE
State	:	NJ
Zip	:	08740-0023
Country	:	US
Telephone Number	:	732-691-1204
Fax Number	:	732-736-9413

Provider Business Practice Location Address
First Line	:	143 W BARNEGAT AVE
Second Line	:
City	:	OCEAN GATE
State	:	NJ
Zip	:	08740-1307
Country	:	US
Telephone Number	:	732-691-1204
Fax Number	:	732-736-9412

Authorized Official
Title or Position	:	AUDIOLOGIST/ OWNER
Name	:	DR. LAURA ANNE PADHAM
Credential	:	AUD
Telephone Number	:	732-691-1204

Provider Enumeration Date	:	06/03/2019
Last Update Date	:	06/03/2019

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