Provider Demographics
NPI:1366447146
Name:LAFERGOLA, PAUL JOHN (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOHN
Last Name:LAFERGOLA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15 ALVIN SLOAN AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-4170
Mailing Address - Country:US
Mailing Address - Phone:973-366-7676
Mailing Address - Fax:973-442-1300
Practice Address - Street 1:387 W BLACKWELL ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-2520
Practice Address - Country:US
Practice Address - Phone:973-366-7676
Practice Address - Fax:973-442-1300
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMD01918213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0818402Medicaid
NJLA583723Medicare ID - Type UnspecifiedMEDICARE
NJ6408110001Medicare NSC
NJT90303Medicare UPIN