Provider Demographics
NPI:1477197341
Name:MORITZ, LAURA (RN, CLC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MORITZ
Suffix:
Gender:F
Credentials:RN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CATALPA DR
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-1508
Mailing Address - Country:US
Mailing Address - Phone:631-365-5217
Mailing Address - Fax:
Practice Address - Street 1:25 CATALPA DR
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-1508
Practice Address - Country:US
Practice Address - Phone:631-365-5217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY696392163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant