Healthcare Provider Details

I. General information

NPI: 1902875461
Provider Name (Legal Business Name): LOURDES R LARAYA CUASAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 ROUTE 37 W RIVERWOOD II BLDG. 3RD FLOOR
TOMS RIVER NJ
08755-6400
US

IV. Provider business mailing address

PO BOX 8000 DEPT 596
BUFFALO NY
14267-0002
US

V. Phone/Fax

Practice location:
  • Phone: 732-557-3541
  • Fax: 732-557-3518
Mailing address:
  • Phone: 866-295-0041
  • Fax: 708-342-2517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number25MA03181200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: