Individual
MR. ERICH LASERNA VIDAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
24 ABEEL ST, NEW BRUNSWICK, NJ 08901-1303
(732) 745-9800
Mailing address
33 JADE LN, PHILLIPSBURG, NJ 08865-7326
(908) 387-9479
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00080600
NJ
Other
Enumeration date
09/20/2011
Last updated
09/20/2011
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