Healthcare Provider Details

I. General information

NPI: 1295956506
Provider Name (Legal Business Name): CAROLYN LAORNO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WESTAGE BUSINESS CTR DR STE 231
FISHKILL NY
12524-2268
US

IV. Provider business mailing address

200 WESTAGE BUSINESS CTR DR STE 231
FISHKILL NY
12524-2268
US

V. Phone/Fax

Practice location:
  • Phone: 845-896-6669
  • Fax: 845-896-2854
Mailing address:
  • Phone: 845-896-6666
  • Fax: 845-896-2854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number17024401
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number008585
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: