Healthcare Provider Details

I. General information

NPI: 1760988430
Provider Name (Legal Business Name): MS. LAURA HELLER PAONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA CORNIOLA

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RIVERVIEW PLZ
RED BANK NJ
07701-1864
US

IV. Provider business mailing address

2 LONG ACRE DR
CREAM RIDGE NJ
08514-1620
US

V. Phone/Fax

Practice location:
  • Phone: 732-741-2700
  • Fax:
Mailing address:
  • Phone: 609-954-8310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00478100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: