Provider Demographics
NPI:1881874477
Name:NAGY, LAURETTE
Entity type:Individual
Prefix:MS
First Name:LAURETTE
Middle Name:
Last Name:NAGY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 JERSEY AVE
Mailing Address - Street 2:APT. 2-F
Mailing Address - City:SPRING LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07762-1879
Mailing Address - Country:US
Mailing Address - Phone:908-307-0644
Mailing Address - Fax:
Practice Address - Street 1:618 JERSEY AVE
Practice Address - Street 2:APT. 2-F
Practice Address - City:SPRING LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07762-1879
Practice Address - Country:US
Practice Address - Phone:908-307-0644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09011800224Z00000X
224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant