Healthcare Provider Details

I. General information

NPI: 1659410959
Provider Name (Legal Business Name): MARY REGINA LASKOWSKI D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2717 MARNE HWY
HAINESPORT NJ
08036-2892
US

IV. Provider business mailing address

2717 MARNE HWY
HAINESPORT NJ
08036-2892
US

V. Phone/Fax

Practice location:
  • Phone: 609-267-5550
  • Fax: 609-267-3535
Mailing address:
  • Phone: 609-267-5550
  • Fax: 609-267-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC003648
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: