Healthcare Provider Details

I. General information

NPI: 1285928887
Provider Name (Legal Business Name): LAURA D TOBIN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 06/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 GROVE AVE SUITE A
VERONA NJ
07044-1730
US

IV. Provider business mailing address

20 LAUREL PL
MONTCLAIR NJ
07043-1213
US

V. Phone/Fax

Practice location:
  • Phone: 973-239-2600
  • Fax:
Mailing address:
  • Phone: 973-744-1451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ00313700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NO10512300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: