Provider Demographics
NPI:1225367808
Name:MORRIS LAITMAN,P.A.
Entity Type:Organization
Organization Name:MORRIS LAITMAN,P.A.
Other - Org Name:LAITMAN,P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LAITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PH,D
Authorized Official - Phone:732-571-3950
Mailing Address - Street 1:9 ABIS PL
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1104
Mailing Address - Country:US
Mailing Address - Phone:732-571-3950
Mailing Address - Fax:732-571-6807
Practice Address - Street 1:9 ABIS PL
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1104
Practice Address - Country:US
Practice Address - Phone:732-571-3950
Practice Address - Fax:732-571-6807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00011800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
035216Medicare PIN