Provider Demographics
NPI:1447449723
Name:LAURIE KRUM SURGICAL SERVICES LLC
Entity type:Organization
Organization Name:LAURIE KRUM SURGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRUM
Authorized Official - Suffix:
Authorized Official - Credentials:APN-C
Authorized Official - Phone:201-265-2314
Mailing Address - Street 1:204 HAASE AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4508
Mailing Address - Country:US
Mailing Address - Phone:201-265-2314
Mailing Address - Fax:201-265-1431
Practice Address - Street 1:204 HAASE AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-4508
Practice Address - Country:US
Practice Address - Phone:201-265-2314
Practice Address - Fax:201-265-1431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ081637163WR0006X
NJ26NJ00137000363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty