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General NPI Number Information
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NPI Number | 1366447146
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Entity Type | Individual
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Provider Name | PAUL JOHN LAFERGOLA D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 08/09/2010
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Provider Practice Location Address
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Address Line | 387 W BLACKWELL ST
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City | DOVER
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State | NJ
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Zip | 07801-2520
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Country | US
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Telephone | 973-366-7676
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Fax | 973-442-1300
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Provider Business Mailing Address
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Address Line | 15 ALVIN SLOAN AVE
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City | WASHINGTON
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State | NJ
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Zip | 07882-4170
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Country | US
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Telephone | 973-366-7676
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Fax | 973-442-1300
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | MD01918
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License Number State | NJ
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