MEDICARE: DR. LAURIE S NAHUM 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
1	207R00000X	Internal Medicine Physician	MA42940	NJ

General Provider Information

NPI Number	:	1558361295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURIE S NAHUM MD

Provider Business Mailing Address
First Line	:	2035 HAMBURG TPKE
Second Line	:	SUITE F
City	:	WAYNE
State	:	NJ
Zip	:	07470-6251
Country	:	US
Telephone Number	:	973-831-9228
Fax Number	:	973-831-9856

Provider Business Practice Location Address
First Line	:	2035 HAMBURG TPKE
Second Line	:	SUITE F
City	:	WAYNE
State	:	NJ
Zip	:	07470-6251
Country	:	US
Telephone Number	:	973-831-9228
Fax Number	:	973-831-9856

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	06/07/2012

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