Healthcare Provider Details

I. General information

NPI: 1164258018
Provider Name (Legal Business Name): THERESA BARBARA GIROUX-LAFAVE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 NEW YORK RD
PLATTSBURGH NY
12903-3981
US

IV. Provider business mailing address

22 NEW YORK RD
PLATTSBURGH NY
12903-3981
US

V. Phone/Fax

Practice location:
  • Phone: 518-561-3803
  • Fax: 518-561-3805
Mailing address:
  • Phone: 518-561-3803
  • Fax: 518-561-3805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: