Healthcare Provider Details

I. General information

NPI: 1609168400
Provider Name (Legal Business Name): MICHELLE LASKI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 18TH AVE
ELMWOOD PARK NJ
07407-3409
US

IV. Provider business mailing address

103 18TH AVE
ELMWOOD PARK NJ
07407-3409
US

V. Phone/Fax

Practice location:
  • Phone: 201-727-9330
  • Fax: 201-425-4527
Mailing address:
  • Phone: 201-727-9330
  • Fax: 201-425-4527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00708100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number26N011515900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: