Provider Demographics
NPI:1871173179
Name:SINGLEY, LATISHA
Entity type:Individual
Prefix:
First Name:LATISHA
Middle Name:
Last Name:SINGLEY
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 1:341 OGDEN ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-3226
Mailing Address - Country:US
Mailing Address - Phone:973-234-7301
Mailing Address - Fax:
Practice Address - Street 1:185 CENTRAL AVE STE 309
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-3318
Practice Address - Country:US
Practice Address - Phone:973-234-7301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-11
Last Update Date:2021-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty