Healthcare Provider Details

I. General information

NPI: 1336396696
Provider Name (Legal Business Name): LAURA LEE A ZICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RTE 9 GRAYMOOR
GARRISON NY
10524-0150
US

IV. Provider business mailing address

PO BOX 150
GARRISON NY
10524-0150
US

V. Phone/Fax

Practice location:
  • Phone: 845-335-1000
  • Fax:
Mailing address:
  • Phone: 845-335-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number4343
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: