Individual
MR. LAQUAN R SHAMBERGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
109 WOODSIDE RD, MAPLEWOOD, NJ 07040-1950
(862) 703-8237
Mailing address
109 WOODSIDE RD, MAPLEWOOD, NJ 07040-1950
(862) 703-8237
Taxonomy
Speciality
Code
Description
License number
State
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
—
NJ
385HR2065X
Child Physical Disabilities Respite Care
—
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121224
—
NJ
Enumeration date
02/16/2022
Last updated
02/16/2022
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