Provider Demographics
NPI:1598323701
Name:DR. LAURA PADHAM -VISITING AUDIOLOGIST
Entity Type:Organization
Organization Name:DR. LAURA PADHAM -VISITING AUDIOLOGIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:PADHAM
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:732-691-1204
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:OCEAN GATE
Mailing Address - State:NJ
Mailing Address - Zip Code:08740-0023
Mailing Address - Country:US
Mailing Address - Phone:732-691-1204
Mailing Address - Fax:732-736-9413
Practice Address - Street 1:143 W BARNEGAT AVE
Practice Address - Street 2:
Practice Address - City:OCEAN GATE
Practice Address - State:NJ
Practice Address - Zip Code:08740-1307
Practice Address - Country:US
Practice Address - Phone:732-691-1204
Practice Address - Fax:732-736-9412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1891157715OtherPERSONAL NPI