Healthcare Provider Details

I. General information

NPI: 1114151867
Provider Name (Legal Business Name): LARISSA KIM LASKOWSKI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 1ST AVE
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

455 1ST AVE RM 123
NEW YORK NY
10016-9102
US

V. Phone/Fax

Practice location:
  • Phone: 212-447-4534
  • Fax:
Mailing address:
  • Phone: 212-447-4534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number267865
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number267865
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: