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NPI Code Detail

MEDICARE: MISS KATHERINE LEE LAURITSEN MD

MEDICARE: MISS KATHERINE LEE LAURITSEN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1033054283
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS KATHERINE LEE LAURITSEN MD
Provider Business Mailing Address
First Line : 185 S ORANGE AVE
Second Line :
City : NEWARK
State : NJ
Zip : 07103-2757
Country : US
Telephone Number : 973-972-6049
Fax Number : 973-972-2229
Provider Business Practice Location Address
First Line : 185 S ORANGE AVE
Second Line :
City : NEWARK
State : NJ
Zip : 07103-2757
Country : US
Telephone Number : 973-972-6049
Fax Number : 973-972-2229
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2026
Last Update Date : 04/23/2026

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