Provider Demographics
NPI:1255733002
Name:KANIA, LAURA
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:KANIA
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 1:949 WILLOUGHBY AVE
Mailing Address - Street 2:APT 306
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-2619
Mailing Address - Country:US
Mailing Address - Phone:239-293-3883
Mailing Address - Fax:
Practice Address - Street 1:949 WILLOUGHBY AVE
Practice Address - Street 2:APT 306
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-2619
Practice Address - Country:US
Practice Address - Phone:239-293-3883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059754183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist