Healthcare Provider Details

I. General information

NPI: 1992026694
Provider Name (Legal Business Name): LAURIE BELOSA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 SPRINGFIELD AVE
WESTFIELD NJ
07090-1024
US

IV. Provider business mailing address

11 PARK PLACE SUITE 1200
NEW YORK NY
10007
US

V. Phone/Fax

Practice location:
  • Phone: 908-588-3740
  • Fax: 908-588-3740
Mailing address:
  • Phone: 212-226-7666
  • Fax: 212-202-7988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08831500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: