Healthcare Provider Details

I. General information

NPI: 1902910193
Provider Name (Legal Business Name): SUZANNE LASKAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 NW 13TH ST STE 5D
BOCA RATON FL
33486
US

IV. Provider business mailing address

951 NW 13TH ST STE 5D
BOCA RATON FL
33486
US

V. Phone/Fax

Practice location:
  • Phone: 561-392-7266
  • Fax: 561-392-7155
Mailing address:
  • Phone: 561-392-7266
  • Fax: 561-392-7155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number46172
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: