Provider Demographics
NPI:1619022878
Name:AMBULATORY AND LASER FOOT SURGERY GROUP
Entity Type:Organization
Organization Name:AMBULATORY AND LASER FOOT SURGERY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:LATORA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-998-3668
Mailing Address - Street 1:312 BELLEVILLE TPKE
Mailing Address - Street 2:
Mailing Address - City:NORTH ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07031-6463
Mailing Address - Country:US
Mailing Address - Phone:201-998-3668
Mailing Address - Fax:201-997-6610
Practice Address - Street 1:312 BELLEVILLE TPKE
Practice Address - Street 2:
Practice Address - City:NORTH ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07031-6463
Practice Address - Country:US
Practice Address - Phone:201-998-3668
Practice Address - Fax:201-997-6610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5482305Medicaid
NJ565761Medicare PIN