Provider Demographics
NPI:1235253600
Name:DR. CHRISTOPHER M LAROSA LLC
Entity Type:Organization
Organization Name:DR. CHRISTOPHER M LAROSA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAROSA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-435-4002
Mailing Address - Street 1:146 LAKEVIEW DR S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GIBBSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08026-1018
Mailing Address - Country:US
Mailing Address - Phone:856-435-4002
Mailing Address - Fax:856-435-4070
Practice Address - Street 1:146 LAKEVIEW DR S
Practice Address - Street 2:SUITE 101
Practice Address - City:GIBBSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08026-1018
Practice Address - Country:US
Practice Address - Phone:856-435-4002
Practice Address - Fax:856-435-4070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD002471213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ480031440OtherRAILDROAD MEDICARE
NJ0829704000OtherAMERIHEALTH
NJ7829108Medicaid
NJ7829108Medicaid
NJ480031440OtherRAILDROAD MEDICARE