Healthcare Provider Details

I. General information

NPI: 1477457836
Provider Name (Legal Business Name): LAURA ELIZABETH MACRON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CAMPUS RD
STATEN ISLAND NY
10301-4495
US

IV. Provider business mailing address

22 VIRGINIA PL
STATEN ISLAND NY
10314-2323
US

V. Phone/Fax

Practice location:
  • Phone: 718-390-3158
  • Fax:
Mailing address:
  • Phone: 347-861-4701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number358873
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: