Provider Demographics
NPI:1538492202
Name:CORYAT, LAURA (NP-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CORYAT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:C
Other - Last Name:MACGREGOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1351 ROUTE 55
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-5108
Mailing Address - Country:US
Mailing Address - Phone:845-475-9661
Mailing Address - Fax:845-475-9938
Practice Address - Street 1:6511 SPRING BROOK AVE
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-3709
Practice Address - Country:US
Practice Address - Phone:845-871-3329
Practice Address - Fax:845-871-4208
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305218363LA2200X
NY552590-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03421652Medicaid
NYA400146986Medicare PIN
NYA400057145Medicare PIN