Provider Demographics
NPI:1164931655
Name:LARA, LINDA ELAINE (MMUSIC; YOGA CERT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ELAINE
Last Name:LARA
Suffix:
Gender:F
Credentials:MMUSIC; YOGA CERT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 STAMETS RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08848-2216
Mailing Address - Country:US
Mailing Address - Phone:908-996-6242
Mailing Address - Fax:
Practice Address - Street 1:449 STAMETS RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:08848-2216
Practice Address - Country:US
Practice Address - Phone:908-996-6242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ020-801-504OtherFEIN