Basic Information
| Provider Information | |||||||||
| NPI: | 1205317294 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELUCA | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | ROSE | ||||||||
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| Credential: | PT, DPT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | CIANO | ||||||||
| OtherFirstName: | LAURA | ||||||||
| OtherMiddleName: | ROSE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 935 ALLWOOD RD | ||||||||
| Address2: | |||||||||
| City: | CLIFTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070121988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739283590 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 265 FRANKLIN AVE | ||||||||
| Address2: | |||||||||
| City: | NUTLEY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071102712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736611207 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2018 | ||||||||
| LastUpdateDate: | 10/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01804400 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.