Healthcare Provider Details

I. General information

NPI: 1669561684
Provider Name (Legal Business Name): LAURA DECARLO R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 E 23RD ST
NEW YORK NY
10010-4516
US

IV. Provider business mailing address

462 15TH ST APT 1L
BROOKLYN NY
11215-5769
US

V. Phone/Fax

Practice location:
  • Phone: 212-677-7400
  • Fax:
Mailing address:
  • Phone: 718-499-0517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number014422-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: