Provider Demographics
NPI:1851922579
Name:LAROSE, EMMANUEL FEQUIERE
Entity Type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:FEQUIERE
Last Name:LAROSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 NORMAN RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106-3309
Mailing Address - Country:US
Mailing Address - Phone:973-388-1304
Mailing Address - Fax:
Practice Address - Street 1:173 NORMAN RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07106-3309
Practice Address - Country:US
Practice Address - Phone:973-388-1304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service