Individual
GLORIA M. LAX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
99 BEAUVOIR AVE, SUMMIT, NJ 07901-3533
(908) 522-2232
(908) 522-0227
Mailing address
307 S EVERGREEN AVE, WOODBURY, NJ 08096-2739
(856) 686-4300
Taxonomy
Speciality
Code
Description
License number
State
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
Primary
MA73539
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8999708
—
NJ
Enumeration date
06/15/2006
Last updated
07/12/2007
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