Healthcare Provider Details

I. General information

NPI: 1619022878
Provider Name (Legal Business Name): AMBULATORY AND LASER FOOT SURGERY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 BELLEVILLE TPKE
NORTH ARLINGTON NJ
07031-6463
US

IV. Provider business mailing address

312 BELLEVILLE TPKE
NORTH ARLINGTON NJ
07031-6463
US

V. Phone/Fax

Practice location:
  • Phone: 201-998-3668
  • Fax: 201-997-6610
Mailing address:
  • Phone: 201-998-3668
  • Fax: 201-997-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL A LATORA
Title or Position: OWNER
Credential: D.P.M.
Phone: 201-998-3668