Provider Demographics
NPI:1144415902
Name:SABBAN, LAURA FISHER (MS RD CSR)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:FISHER
Last Name:SABBAN
Suffix:
Gender:F
Credentials:MS RD CSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 OLD SHORT HILLS RD
Mailing Address - Street 2:APT. 289
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1098
Mailing Address - Country:US
Mailing Address - Phone:973-736-9370
Mailing Address - Fax:
Practice Address - Street 1:115 OLD SHORT HILLS RD
Practice Address - Street 2:APT. 289
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1009
Practice Address - Country:US
Practice Address - Phone:973-736-9370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ054057Medicare PIN