Healthcare Provider Details

I. General information

NPI: 1912482340
Provider Name (Legal Business Name): LAURA ANN KALITZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA ANN MCCANN PA-C

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 YOUNG AVE STE 245
MOORESTOWN NJ
08057-3132
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 609-267-9400
  • Fax: 609-267-9457
Mailing address:
  • Phone: 609-267-9400
  • Fax: 609-267-9457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00490200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: