Provider Demographics
NPI:1548547268
Name:SECZECH, LAURA E (PA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:SECZECH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:1613 ROUTE 38 FL 1
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-2921
Practice Address - Country:US
Practice Address - Phone:856-355-7130
Practice Address - Fax:856-355-7131
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2020-10-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA055347363AM0700X
NJ25MP00269000363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232983Medicare PIN
NJ231411Medicare PIN