Healthcare Provider Details

I. General information

NPI: 1639660335
Provider Name (Legal Business Name): LAURA HEUZEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 VALENTINE RD
BLOOMFIELD NJ
07003-3868
US

IV. Provider business mailing address

37 VALENTINE RD
BLOOMFIELD NJ
07003-3868
US

V. Phone/Fax

Practice location:
  • Phone: 631-357-2741
  • Fax:
Mailing address:
  • Phone: 631-357-2741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT01049100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: