MEDICARE: MR. LAURENT ST GERARD

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	171M00000X	Case Manager/Care Coordinator		NY

General Provider Information

NPI Number	:	1639561327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LAURENT ST GERARD

Provider Business Mailing Address
First Line	:	4314 216TH ST
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11361-2943
Country	:	US
Telephone Number	:	718-708-1668
Fax Number	:

Provider Business Practice Location Address
First Line	:	4314 216TH ST
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11361-2943
Country	:	US
Telephone Number	:	718-708-1668
Fax Number	:

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

Provider Enumeration Date	:	03/04/2015
Last Update Date	:	03/04/2015

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Directions to “ MR. LAURENT ST GERARD ” Practice Location

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