Provider Demographics
NPI:1497003990
Name:GEELAN-LOMANTO, LAURA
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:GEELAN-LOMANTO
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 1:274 RADIO AVE
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-3526
Mailing Address - Country:US
Mailing Address - Phone:631-767-3116
Mailing Address - Fax:
Practice Address - Street 1:274 RADIO AVE
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-3526
Practice Address - Country:US
Practice Address - Phone:631-767-3116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist