Provider Demographics
NPI:1760184329
Name:LEVERICH, LAURA ANNE
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANNE
Last Name:LEVERICH
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 1:80 LILLIAN RD
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-3134
Mailing Address - Country:US
Mailing Address - Phone:631-617-2986
Mailing Address - Fax:
Practice Address - Street 1:1023 PULASKI RD
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-1948
Practice Address - Country:US
Practice Address - Phone:631-261-7740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program