Healthcare Provider Details

I. General information

NPI: 1376151647
Provider Name (Legal Business Name): REBECCA ORBINE LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 MEMORIAL PKWY STE 3
PHILLIPSBURG NJ
08865-1580
US

IV. Provider business mailing address

370 MEMORIAL PKWY STE 3
PHILLIPSBURG NJ
08865-1580
US

V. Phone/Fax

Practice location:
  • Phone: 908-454-4470
  • Fax: 908-454-5317
Mailing address:
  • Phone: 908-454-4470
  • Fax: 908-454-5317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37AC00517600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: