Healthcare Provider Details

I. General information

NPI: 1285709204
Provider Name (Legal Business Name): ANTHONY ANGELO LAFFERTY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 10/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 COMMERCE LN SUITE 1
WEST BERLIN NJ
08091-2513
US

IV. Provider business mailing address

403 COMMERCE LN SUITE 1
WEST BERLIN NJ
08091-2513
US

V. Phone/Fax

Practice location:
  • Phone: 856-768-7737
  • Fax: 856-768-4477
Mailing address:
  • Phone: 856-768-7737
  • Fax: 856-768-4477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC006602L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00484700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: