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General NPI Number Information
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NPI Number | 1174521363
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Entity Type | Individual
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Provider Name | LAURA ELLEN STAFF MD
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Gender | Female
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 09/27/2017
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Provider Practice Location Address
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Address Line | 3 WEMBLEY CT STE 101
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City | ALBANY
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State | NY
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Zip | 12205-3891
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Country | US
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Telephone | 518-869-4300
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Fax | 518-869-8386
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Provider Business Mailing Address
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Address Line | 22 RIDGEFIELD ST
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City | ALBANY
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State | NY
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Zip | 12208-2908
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 198187
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License Number State | NY
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