Healthcare Provider Details

I. General information

NPI: 1275728818
Provider Name (Legal Business Name): LAURA CZULADA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NICOLLS RD
STONY BROOK NY
11794-0001
US

IV. Provider business mailing address

18 HILLCREST ST
HUNTINGTON NY
11743-3425
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-2725
  • Fax:
Mailing address:
  • Phone: 267-980-4640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number265351
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: