Healthcare Provider Details

I. General information

NPI: 1952843302
Provider Name (Legal Business Name): LAURA LYNOTT M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 TOWER DR STE 400
MIDDLETOWN NY
10941-2057
US

IV. Provider business mailing address

192 TOWER DR STE 400
MIDDLETOWN NY
10941-2057
US

V. Phone/Fax

Practice location:
  • Phone: 845-692-4391
  • Fax:
Mailing address:
  • Phone: 845-692-4391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number805244
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number1849316
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: