=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447449723
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAURIE KRUM SURGICAL SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2007
-----------------------------------------------------
Last Update Date | 10/23/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 204 HAASE AVE
-----------------------------------------------------
City | PARAMUS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07652-4508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-265-2314
-----------------------------------------------------
Fax | 201-265-1431
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 204 HAASE AVE
-----------------------------------------------------
City | PARAMUS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07652-4508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-265-2314
-----------------------------------------------------
Fax | 201-265-1431
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | LAURIE J KRUM
-----------------------------------------------------
Credential | APN-C
-----------------------------------------------------
Telephone | 201-265-2314
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WR0006X
-----------------------------------------------------
Taxonomy Name | Registered Nurse First Assistant
-----------------------------------------------------
License Number | 081637
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 26NJ00137000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------