Healthcare Provider Details

I. General information

NPI: 1629036447
Provider Name (Legal Business Name): VINCENT LASORSA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3644 VALLEY RD
LIBERTY CORNER NJ
07938
US

IV. Provider business mailing address

PO BOX 221 3644 VALLEY RD
LIBERTY CORNER NJ
07938-0221
US

V. Phone/Fax

Practice location:
  • Phone: 908-647-7766
  • Fax: 908-647-7769
Mailing address:
  • Phone: 908-647-7766
  • Fax: 908-647-7769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC004321
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: