Healthcare Provider Details

I. General information

NPI: 1295720563
Provider Name (Legal Business Name): KENNETH A LAUGHINGHOUSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 WHITE RD SUITE 101
LITTLE SILVER NJ
07739-1166
US

IV. Provider business mailing address

180 WHITE RD SUITE 101
LITTLE SILVER NJ
07739-1166
US

V. Phone/Fax

Practice location:
  • Phone: 732-530-8666
  • Fax: 732-530-7911
Mailing address:
  • Phone: 732-530-8666
  • Fax: 732-530-7911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA06564400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: