Provider Demographics
NPI:1699372300
Name:NADOSY, LARA
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:NADOSY
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 1:600 MONTAUK HWY STE C
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-2235
Mailing Address - Country:US
Mailing Address - Phone:631-638-7820
Mailing Address - Fax:
Practice Address - Street 1:600 MONTAUK HWY STE C
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-2235
Practice Address - Country:US
Practice Address - Phone:631-638-7820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife