Basic Information
Provider Information
NPI: 1396059317
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAURETI
FirstName: JOSEPH
MiddleName: ANTHONY
NamePrefix: DR.
NameSuffix: III
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3435 WINCHESTER RD
Address2:  
City: ALLENTOWN
State: PA
PostalCode: 181042268
CountryCode: US
TelephoneNumber: 6108618080
FaxNumber:  
Practice Location
Address1: 1503 N CEDAR CREST BLVD
Address2:  
City: ALLENTOWN
State: PA
PostalCode: 18104
CountryCode: US
TelephoneNumber: 6108618080
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/02/2010
LastUpdateDate: 07/16/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XOS016046PAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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