Healthcare Provider Details

I. General information

NPI: 1780505701
Provider Name (Legal Business Name): LAURA BAIRD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 HART AVE
STATEN ISLAND NY
10310-3022
US

IV. Provider business mailing address

214 HART AVE
STATEN ISLAND NY
10310-3022
US

V. Phone/Fax

Practice location:
  • Phone: 347-359-3295
  • Fax:
Mailing address:
  • Phone: 347-359-3295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1420693
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: