Healthcare Provider Details

I. General information

NPI: 1023397627
Provider Name (Legal Business Name): LAURA PISANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY COLUMBIA UNIVERSITY MEDICAL CENTER/CLINICAL GENETICS
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

3959 BROADWAY COLUMBIA UNIVERSITY MEDICAL CENTER/CLINICAL GENETICS
NEW YORK NY
10032-1559
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-6731
  • Fax:
Mailing address:
  • Phone: 212-305-6731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number278678
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: