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NPI Code Detail

MEDICARE: LAURELTON MEDICAL PHYSICIANS PLLC

MEDICARE: LAURELTON MEDICAL PHYSICIANS PLLC
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
1261QM2500XMedical Specialty Clinic/Center178587NY
2261Q00000XClinic/Center178587NY

General Provider Information

NPI Number : 1902216229
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAURELTON MEDICAL PHYSICIANS PLLC
Provider Business Mailing Address
First Line : 22414 MERRICK BLVD
Second Line :
City : LAURELTON
State : NY
Zip : 11413-2023
Country : US
Telephone Number : 718-949-6433
Fax Number : 718-949-0331
Provider Business Practice Location Address
First Line : 22414 MERRICK BLVD
Second Line :
City : LAURELTON
State : NY
Zip : 11413-2023
Country : US
Telephone Number : 718-949-6433
Fax Number : 718-949-0331
Authorized Official
Title or Position : OWNER
Name : RICHARD WATSON
Credential : MD
Telephone Number : 718-949-6433
Provider Enumeration Date : 05/08/2014
Last Update Date : 01/15/2026

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Directions to “LAURELTON MEDICAL PHYSICIANS PLLC ” Practice Location

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