Provider Demographics
NPI:1265715577
Name:PULKOSKI, LAURA A (OTR)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:A
Last Name:PULKOSKI
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:PULKOSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:234 BEACH 119TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1977
Mailing Address - Country:US
Mailing Address - Phone:718-474-4203
Mailing Address - Fax:718-474-4203
Practice Address - Street 1:234 BEACH 119TH ST
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-1977
Practice Address - Country:US
Practice Address - Phone:718-474-4203
Practice Address - Fax:718-474-4203
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018360-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist