Healthcare Provider Details

I. General information

NPI: 1508005935
Provider Name (Legal Business Name): LAURA TAHIR PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 07/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 S MAIN ST # 694
ALLENTOWN NJ
08501-1683
US

IV. Provider business mailing address

41 GERALDINE RD
EAST WINDSOR NJ
08520-2631
US

V. Phone/Fax

Practice location:
  • Phone: 609-443-3828
  • Fax:
Mailing address:
  • Phone: 609-443-3828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3065
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: