Provider Demographics
NPI:1295158202
Name:DECESARIS, LAURA (DC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:DECESARIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 HANOVER RD
Mailing Address - Street 2:BLDG 300
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1411
Mailing Address - Country:US
Mailing Address - Phone:973-240-7251
Mailing Address - Fax:
Practice Address - Street 1:17 HANOVER RD
Practice Address - Street 2:BLDG 300
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1411
Practice Address - Country:US
Practice Address - Phone:973-240-7251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00714000111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition