Healthcare Provider Details

I. General information

NPI: 1184317653
Provider Name (Legal Business Name): LAURA TARBERRY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 MONROE ST STE E512
HOBOKEN NJ
07030-6360
US

IV. Provider business mailing address

720 MONROE ST STE E512
HOBOKEN NJ
07030-6360
US

V. Phone/Fax

Practice location:
  • Phone: 917-647-1665
  • Fax:
Mailing address:
  • Phone: 917-647-1665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number0789
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: