Physician Compare National (NPI:1740335306)

HEALTHCARE PROVIDER: LAURENCE ANTOSZ PH.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1740335306
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4587560180
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20160224000305
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ANTOSZ
	Individual professional last name
Provider First Name	LAURENCE
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	MICHIGAN STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE
	Individual professional's medical school
Graduation Year	1990
	Individual professional's medical school graduation year
Primary Specialty	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	363 MAIN ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 405
	Group Practice or individual's line 2 address
City	MIDDLETOWN
	Group Practice or individual's city
State	CT
	Group Practice or individual's state
Zip Code	064573359
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8604289842
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y