Provider Demographics
NPI:1497999882
Name:VAN DE LAAR, LAURA F (NPP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:F
Last Name:VAN DE LAAR
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 N PLANK RD
Mailing Address - Street 2:SUITE R-2
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-2116
Mailing Address - Country:US
Mailing Address - Phone:845-562-0168
Mailing Address - Fax:845-562-0169
Practice Address - Street 1:34 NORTH PLANK ROAD
Practice Address - Street 2:SUITE R-2
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550
Practice Address - Country:US
Practice Address - Phone:845-562-0168
Practice Address - Fax:845-562-0169
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401205363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00542503Medicaid