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General NPI Number Information
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NPI Number | 1639185291
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Entity Type | Individual
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Provider Name | JOHN LAURIELLO MD
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 11/21/2019
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Provider Practice Location Address
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Address Line | 833 CHESTNUT ST STE 210
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4405
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Country | US
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Telephone | 215-955-6913
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Fax |
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Provider Business Mailing Address
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Address Line | 833 CHESTNUT ST STE 210
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4405
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Country | US
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Telephone | 215-955-6913
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 94-296
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2009006926
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License Number State | MO
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