Healthcare Provider Details

I. General information

NPI: 1740517457
Provider Name (Legal Business Name): LAURY A CUDDIHY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURY A HASKAMP MD

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 PRINCETON PIKE BLDG 1, C/O INSTITUTE FOR SPINE & SCOLIOSIS
LAWRENCEVILLE NJ
08648-2300
US

IV. Provider business mailing address

3100 PRINCETON PIKE BLDG 1, C/O INSTITUTE FOR SPINE & SCOLIOSIS
LAWRENCEVILLE NJ
08648-2300
US

V. Phone/Fax

Practice location:
  • Phone: 609-912-1500
  • Fax:
Mailing address:
  • Phone: 609-912-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberMS437351
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number25MA08635900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number256968
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number018421
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: