Healthcare Provider Details

I. General information

NPI: 1962524892
Provider Name (Legal Business Name): NATALYA LASKINA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 MIDDLE COUNTRY RD
CORAM NY
11727-4425
US

IV. Provider business mailing address

266 MIDDLE COUNTRY RD
CORAM NY
11727-4425
US

V. Phone/Fax

Practice location:
  • Phone: 631-698-1111
  • Fax: 631-698-9389
Mailing address:
  • Phone: 631-698-1111
  • Fax: 631-698-9389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number006297
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: