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General NPI Number Information
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NPI Number | 1760572051
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Entity Type | Individual
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Provider Name | LAURA J STOUGH PA
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Gender | Female
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Dates
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Enumeration Date | 10/15/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 721 HOMESTEAD AVE
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City | MAYBROOK
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State | NY
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Zip | 12543-1307
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Country | US
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Telephone | 845-427-0884
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Fax | 845-427-9072
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Provider Business Mailing Address
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Address Line | 158 N MAIN ST PO BOX 299
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City | FLORIDA
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State | NY
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Zip | 10921-1133
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Country | US
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Telephone | 845-651-1400
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Fax | 845-651-1510
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 010959
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License Number State | NY
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