Provider Demographics
NPI:1790036663
Name:BISHTON, LAURIE
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:BISHTON
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 1:2282 THAYER RD
Mailing Address - Street 2:
Mailing Address - City:HUBBARDSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13355-1108
Mailing Address - Country:US
Mailing Address - Phone:315-723-2723
Mailing Address - Fax:
Practice Address - Street 1:10 EATON ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NY
Practice Address - Zip Code:13346-1124
Practice Address - Country:US
Practice Address - Phone:315-750-9693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000023850237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist