Provider Demographics
NPI:1669599957
Name:LAURIA, PAUL DAMIAN (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAMIAN
Last Name:LAURIA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 RADIO RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE EGG HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08087
Mailing Address - Country:US
Mailing Address - Phone:609-296-8292
Mailing Address - Fax:609-296-5716
Practice Address - Street 1:871 RADIO RD
Practice Address - Street 2:
Practice Address - City:LITTLE EGG HARBOR
Practice Address - State:NJ
Practice Address - Zip Code:08087
Practice Address - Country:US
Practice Address - Phone:609-296-8292
Practice Address - Fax:609-296-5716
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00197100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
87989Medicare PIN
87989Medicare ID - Type Unspecified