Provider Demographics
NPI:1326112400
Name:MULVEY, LAURI DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURI
Middle Name:DIANE
Last Name:MULVEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAURI
Other - Middle Name:DIANE
Other - Last Name:MULVEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:213 NASSAU STREET
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08542
Mailing Address - Country:US
Mailing Address - Phone:609-924-1661
Mailing Address - Fax:609-924-8728
Practice Address - Street 1:213 NASSAU STREET
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08542
Practice Address - Country:US
Practice Address - Phone:609-924-1661
Practice Address - Fax:609-924-8728
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03996900207W00000X
PAMD026021E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology