MEDICARE: LAURA ANNE PELLEGRINO NP

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	363LA2200X	Adult Health Nurse Practitioner	308856	NY

General Provider Information

NPI Number	:	1952889339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ANNE PELLEGRINO NP

Provider Business Mailing Address
First Line	:	1180 CASSEL AVE
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-6116
Country	:	US
Telephone Number	:	516-236-1449
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 NEW YORK AVE
Second Line	:
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-4601
Country	:	US
Telephone Number	:	516-799-2555
Fax Number	:

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

Provider Enumeration Date	:	07/30/2018
Last Update Date	:	07/30/2018

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