Provider Demographics
NPI:1003825258
Name:LAUB, ALLEN STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:STEVEN
Last Name:LAUB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 RAMAPO RD
Mailing Address - Street 2:
Mailing Address - City:GARNERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10923-1552
Mailing Address - Country:US
Mailing Address - Phone:845-947-1772
Mailing Address - Fax:845-947-4487
Practice Address - Street 1:171 RAMAPO RD
Practice Address - Street 2:
Practice Address - City:GARNERVILLE
Practice Address - State:NY
Practice Address - Zip Code:10923-1552
Practice Address - Country:US
Practice Address - Phone:845-947-1772
Practice Address - Fax:845-947-4487
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097040208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00417854Medicaid
B17244Medicare UPIN