Provider Demographics
NPI:1659636967
Name:DUTU, LAURA (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:DUTU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PROSPECT AVE STE 715
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1989
Mailing Address - Country:US
Mailing Address - Phone:201-881-0721
Mailing Address - Fax:201-881-0725
Practice Address - Street 1:20 PROSPECT AVE STE 715
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1989
Practice Address - Country:US
Practice Address - Phone:201-881-0721
Practice Address - Fax:201-881-0725
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278605207R00000X
NJ25MA10187700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine