Healthcare Provider Details

I. General information

NPI: 1447449723
Provider Name (Legal Business Name): LAURIE KRUM SURGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 HAASE AVE
PARAMUS NJ
07652-4508
US

IV. Provider business mailing address

204 HAASE AVE
PARAMUS NJ
07652-4508
US

V. Phone/Fax

Practice location:
  • Phone: 201-265-2314
  • Fax: 201-265-1431
Mailing address:
  • Phone: 201-265-2314
  • Fax: 201-265-1431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number081637
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00137000
License Number StateNJ

VIII. Authorized Official

Name: LAURIE J KRUM
Title or Position: AUTHORIZED OFFICIAL
Credential: APN-C
Phone: 201-265-2314