Healthcare Provider Details

I. General information

NPI: 1033020821
Provider Name (Legal Business Name): COURTNEY RACHEL LAURO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HARBOR VIEW TER
EDGEWATER NJ
07020-1189
US

IV. Provider business mailing address

110 HARBOR VIEW TER
EDGEWATER NJ
07020-1189
US

V. Phone/Fax

Practice location:
  • Phone: 732-403-4607
  • Fax:
Mailing address:
  • Phone: 732-403-4607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86108337
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: