Healthcare Provider Details

I. General information

NPI: 1740946300
Provider Name (Legal Business Name): ELIZABETH J LAATSCH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 BEY LEA RD STE B203
TOMS RIVER NJ
08753-2974
US

IV. Provider business mailing address

121 WOODLAND LANE REAR APT FLOOR 1
AVON-BY-THE-SEA NJ
07717
US

V. Phone/Fax

Practice location:
  • Phone: 732-341-0720
  • Fax:
Mailing address:
  • Phone: 267-222-2353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00659600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: