Provider Demographics
NPI:1164093639
Name:LAUTSCH, ALISHA MARIE
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:MARIE
Last Name:LAUTSCH
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 1:297 TOWN LINE RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-5502
Mailing Address - Country:US
Mailing Address - Phone:631-223-6636
Mailing Address - Fax:
Practice Address - Street 1:297 TOWN LINE RD
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-5502
Practice Address - Country:US
Practice Address - Phone:631-223-6636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant