Provider Demographics
NPI:1528189222
Name:GANNY, LAURA V
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:V
Last Name:GANNY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1467 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2418
Mailing Address - Country:US
Mailing Address - Phone:732-494-1820
Mailing Address - Fax:732-549-7343
Practice Address - Street 1:1467 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2418
Practice Address - Country:US
Practice Address - Phone:732-494-1820
Practice Address - Fax:732-549-7343
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ1935156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician