Healthcare Provider Details

I. General information

NPI: 1033959317
Provider Name (Legal Business Name): LAURA RINA CECCHETTO FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2024
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 E MAIN ST
MENDHAM NJ
07945-1503
US

IV. Provider business mailing address

19 E MAIN ST
MENDHAM NJ
07945-1503
US

V. Phone/Fax

Practice location:
  • Phone: 973-543-6505
  • Fax: 973-543-2967
Mailing address:
  • Phone: 973-543-6505
  • Fax: 973-543-2967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15036000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: