Individual
DR. CAROL ANDREA LAURETTE PENN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
72 HARRISON AVE, RED BANK, NJ 07701-2375
(732) 363-6655
Mailing address
101 2ND ST, LAKEWOOD, NJ 08701-3324
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MB09343300
NJ
207Q00000X
Family Medicine Physician
OT014041
PA
Other
Enumeration date
08/04/2011
Last updated
04/08/2016
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