MEDICARE: DR. LAURA HESSELINK D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	25MB09893600	NJ
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1194141465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA HESSELINK D.O.

Provider Business Mailing Address
First Line	:	7559 263RD ST
Second Line	:	THE ZUCKER HILLSIDE HOSPITAL ACP BUILDING
City	:	GLEN OAKS
State	:	NY
Zip	:	11004-1150
Country	:	US
Telephone Number	:	718-470-3511
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 REGENT ST
Second Line	:	SUITE 518
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-1675
Country	:	US
Telephone Number	:	973-994-1011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2014
Last Update Date	:	07/05/2016

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