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General NPI Number Information
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NPI Number | 1467018630
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Entity Type | Individual
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Provider Name | LAURY ANTHENOR
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Gender | Female
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Dates
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Enumeration Date | 05/14/2019
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Last Update Date | 05/14/2019
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Provider Practice Location Address
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Address Line | 2130 MILLBURN AVE STE D3
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City | MAPLEWOOD
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State | NJ
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Zip | 07040-3725
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Country | US
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Telephone | 908-884-4937
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Fax |
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Provider Business Mailing Address
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Address Line | 1263 BISCAYNE BLVD
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City | UNION
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State | NJ
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Zip | 07083-6224
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Country | US
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Telephone | 347-251-2681
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Fax |
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HP0289700
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License Number State |
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