Healthcare Provider Details

I. General information

NPI: 1538158290
Provider Name (Legal Business Name): STEPHEN G. LASKY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1082 CASTLETON AVE
STATEN ISLAND NY
10310-1710
US

IV. Provider business mailing address

1082 CASTLETON AVE
STATEN ISLAND NY
10310-1710
US

V. Phone/Fax

Practice location:
  • Phone: 718-727-6026
  • Fax: 718-727-4308
Mailing address:
  • Phone: 718-727-6026
  • Fax: 718-727-4308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number029146
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: