Healthcare Provider Details

I. General information

NPI: 1871750968
Provider Name (Legal Business Name): SCOTT LAIFER R.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2008
Last Update Date: 05/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 ROUTE 206
HILLSBOROUGH NJ
08844-5523
US

IV. Provider business mailing address

PO BOX 948
GREEN BROOK NJ
08812-0948
US

V. Phone/Fax

Practice location:
  • Phone: 908-281-1090
  • Fax: 732-968-3944
Mailing address:
  • Phone: 908-281-1090
  • Fax: 732-968-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number850715
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: