Healthcare Provider Details

I. General information

NPI: 1598323701
Provider Name (Legal Business Name): DR. LAURA PADHAM -VISITING AUDIOLOGIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 06/03/2019
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: 732-736-9412
Mailing address:
  • Phone: 732-691-1204
  • Fax: 732-736-9413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355A2700X
TaxonomyAudiology Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. LAURA ANNE PADHAM
Title or Position: AUDIOLOGIST/ OWNER
Credential: AUD
Phone: 732-691-1204