Provider Demographics
NPI:1538193784
Name:SCISCENTE, LAURIE A
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:SCISCENTE
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 1:325 PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1617
Mailing Address - Country:US
Mailing Address - Phone:609-924-8131
Mailing Address - Fax:609-683-7559
Practice Address - Street 1:727 STATE RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1413
Practice Address - Country:US
Practice Address - Phone:609-924-8131
Practice Address - Fax:609-924-6699
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011422-1225100000X
NJ40QA00589200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA00589200OtherLICENSE