Provider Demographics
NPI:1457600447
Name:GALORENZO, CARA (LAC MSTOM)
Entity Type:Individual
Prefix:MS
First Name:CARA
Middle Name:
Last Name:GALORENZO
Suffix:
Gender:F
Credentials:LAC MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 FRANKLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1849
Mailing Address - Country:US
Mailing Address - Phone:201-689-0110
Mailing Address - Fax:
Practice Address - Street 1:171 FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1849
Practice Address - Country:US
Practice Address - Phone:201-689-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00093400171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist