Healthcare Provider Details

I. General information

NPI: 1164499430
Provider Name (Legal Business Name): LAURENE DIPASQUALE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2006
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LANGERFELD RD
HILLSDALE NJ
07642-1008
US

IV. Provider business mailing address

1 LANGERFELD RD
HILLSDALE NJ
07642-1008
US

V. Phone/Fax

Practice location:
  • Phone: 201-664-8663
  • Fax: 201-664-8705
Mailing address:
  • Phone: 201-664-8663
  • Fax: 201-664-8705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMA049846
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: