Provider Demographics
NPI:1871818716
Name:BRUSCO, LAURIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:
Last Name:BRUSCO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:COMPOSTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1275 YORK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6007
Mailing Address - Country:US
Mailing Address - Phone:212-639-8093
Mailing Address - Fax:646-422-2340
Practice Address - Street 1:160 E 53RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5243
Practice Address - Country:US
Practice Address - Phone:212-610-0563
Practice Address - Fax:212-588-1371
Is Sole Proprietor?:No
Enumeration Date:2010-04-04
Last Update Date:2010-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304732-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health