Provider Demographics
NPI:1790843902
Name:PILUSO-WILLSON, LAURA JEANNE (DPM)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:JEANNE
Last Name:PILUSO-WILLSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:JEANNE
Other - Last Name:PILUSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:4683 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6021
Mailing Address - Country:US
Mailing Address - Phone:516-799-2525
Mailing Address - Fax:516-799-0015
Practice Address - Street 1:4683 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6021
Practice Address - Country:US
Practice Address - Phone:516-799-2525
Practice Address - Fax:516-799-0015
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005448213EP1101X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01909035Medicaid
NYPA4282Medicare ID - Type Unspecified
NY01909035Medicaid