Provider Demographics
NPI:1043296320
Name:EMERSON, TODD LANE (INDEPENDENT DUTY HS)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:LANE
Last Name:EMERSON
Suffix:
Gender:M
Credentials:INDEPENDENT DUTY HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MUNRO AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08204-5000
Mailing Address - Country:US
Mailing Address - Phone:609-898-6860
Mailing Address - Fax:609-898-6962
Practice Address - Street 1:1 MUNRO AVE
Practice Address - Street 2:
Practice Address - City:CAPE MAY
Practice Address - State:NJ
Practice Address - Zip Code:08204-5000
Practice Address - Country:US
Practice Address - Phone:609-898-6860
Practice Address - Fax:609-898-6962
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other