Healthcare Provider Details

I. General information

NPI: 1891255279
Provider Name (Legal Business Name): LAURENIE G LOUISSAINT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 02/25/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE # 30
BROOKLYN NY
11203-2012
US

IV. Provider business mailing address

195 CLARKSON AVE PH D
BROOKLYN NY
11226-8421
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-6798
  • Fax:
Mailing address:
  • Phone: 248-567-9824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number328424
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number328424
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: