Provider Demographics
NPI:1538381405
Name:DOTI, LAURA A (NP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:DOTI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 EXPRESSWAY DRIVE NORTH
Mailing Address - Street 2:SUITE #116
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749
Mailing Address - Country:US
Mailing Address - Phone:631-292-6747
Mailing Address - Fax:631-292-6767
Practice Address - Street 1:3001 EXPRESSWAY DRIVE NORTH
Practice Address - Street 2:SUITE #116
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749
Practice Address - Country:US
Practice Address - Phone:631-292-6747
Practice Address - Fax:631-292-6767
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY42-420652363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner