Provider Demographics
NPI:1447426796
Name:DELLORUSSO, LAURA MARIE (APN, C)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:MARIE
Last Name:DELLORUSSO
Suffix:
Gender:F
Credentials:APN, C
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN, C
Mailing Address - Street 1:11 MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2242
Mailing Address - Country:US
Mailing Address - Phone:732-663-0300
Mailing Address - Fax:732-663-0301
Practice Address - Street 1:11 MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-2242
Practice Address - Country:US
Practice Address - Phone:732-663-0300
Practice Address - Fax:732-663-0301
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00079100363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0270865Medicaid
NJ224877U77Medicare PIN