Healthcare Provider Details

I. General information

NPI: 1477720506
Provider Name (Legal Business Name): LAURIE G BEDARD M.A., LA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 E MAIN ST SUITE 1
EAST ISLIP NY
11730-2800
US

IV. Provider business mailing address

369 E MAIN ST SUITE 1
EAST ISLIP NY
11730-2800
US

V. Phone/Fax

Practice location:
  • Phone: 631-277-6000
  • Fax: 631-277-6862
Mailing address:
  • Phone: 631-277-6000
  • Fax: 631-277-6862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number962-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: