Provider Demographics
NPI:1538242516
Name:LABOSCO, LOUIS A (MD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:A
Last Name:LABOSCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 CRANBURY RD
Mailing Address - Street 2:SUITE LL 90
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4098
Mailing Address - Country:US
Mailing Address - Phone:732-967-0033
Mailing Address - Fax:732-967-0055
Practice Address - Street 1:620 CRANBURY RD
Practice Address - Street 2:SUITE LL 90
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4098
Practice Address - Country:US
Practice Address - Phone:732-257-0081
Practice Address - Fax:732-613-4845
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02430100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist