Healthcare Provider Details

I. General information

NPI: 1275652208
Provider Name (Legal Business Name): LARYSA ZAPUTOWYCZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 09/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 PLEASANT VALLEY WAY
WEST ORANGE NJ
07052-2956
US

IV. Provider business mailing address

1500 PLEASANT VALLEY WAY
WEST ORANGE NJ
07052-2956
US

V. Phone/Fax

Practice location:
  • Phone: 973-261-1470
  • Fax: 973-651-0197
Mailing address:
  • Phone: 973-261-1470
  • Fax: 973-651-0197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number25MA06762000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: