Healthcare Provider Details

I. General information

NPI: 1669298105
Provider Name (Legal Business Name): KAYLA LAX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 HOPE RD
EATONTOWN NJ
07724-1277
US

IV. Provider business mailing address

1439 READ PL
LAKEWOOD NJ
08701-5431
US

V. Phone/Fax

Practice location:
  • Phone: 732-858-5432
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL07184900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: