Provider Demographics
NPI:1548645955
Name:KOSAR, LARA DENYSE
Entity type:Individual
Prefix:MISS
First Name:LARA
Middle Name:DENYSE
Last Name:KOSAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BETHANY DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-1609
Mailing Address - Country:US
Mailing Address - Phone:516-474-1290
Mailing Address - Fax:
Practice Address - Street 1:10 BETHANY DR
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-1609
Practice Address - Country:US
Practice Address - Phone:516-474-1290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY737151131174400000X
NY716623131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist