Healthcare Provider Details

I. General information

NPI: 1891157715
Provider Name (Legal Business Name): LAURA ANNE PADHAM AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 W BARNEGAT AVE
OCEAN GATE NJ
08740-1307
US

IV. Provider business mailing address

PO BOX 23
OCEAN GATE NJ
08740-0023
US

V. Phone/Fax

Practice location:
  • Phone: 732-691-1204
  • Fax: 732-732-9413
Mailing address:
  • Phone: 732-691-1204
  • Fax: 732-942-7225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: