Provider Demographics
NPI:1548672546
Name:HIRST, LAURA
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:HIRST
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:JEANETTE
Other - Last Name:PICCIONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:570 CARMAN AVE
Mailing Address - Street 2:WESTBURY
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-6539
Mailing Address - Country:US
Mailing Address - Phone:516-414-8143
Mailing Address - Fax:
Practice Address - Street 1:570 CARMAN AVE
Practice Address - Street 2:WESTBURY
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-6539
Practice Address - Country:US
Practice Address - Phone:516-414-8143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-24
Last Update Date:2014-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1092183174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist