Provider Demographics
NPI:1457489981
Name:PRUSAK, LAWRENCE H (MA)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:H
Last Name:PRUSAK
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HOSPITAL DR STE 106
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-6670
Mailing Address - Country:US
Mailing Address - Phone:413-533-3516
Mailing Address - Fax:
Practice Address - Street 1:10 HOSPITAL DR STE 106
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-6612
Practice Address - Country:US
Practice Address - Phone:413-533-3516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA164237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110028572AMedicaid