Healthcare Provider Details

I. General information

NPI: 1093036485
Provider Name (Legal Business Name): ANTONIO LASORSA D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2010
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 VALLEY HEALTH PLZ
PARAMUS NJ
07652-3619
US

IV. Provider business mailing address

235 BERKELEY RD
RIVER EDGE NJ
07661-1213
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-8000
  • Fax:
Mailing address:
  • Phone: 917-562-0020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number25MB09231000
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: