Provider Demographics
NPI:1184282147
Name:GOLDSMITH, LAURA JEANNE (ATC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JEANNE
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:JEANNE
Other - Last Name:POORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:367 SILVIA ST
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-3231
Mailing Address - Country:US
Mailing Address - Phone:401-824-9697
Mailing Address - Fax:
Practice Address - Street 1:176 EDGERSTOUNE RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6799
Practice Address - Country:US
Practice Address - Phone:609-921-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT002196002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer