Provider Demographics
NPI:1336351188
Name:LARTEY, LAUD
Entity Type:Individual
Prefix:MR
First Name:LAUD
Middle Name:
Last Name:LARTEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 LACOMBE AVE
Mailing Address - Street 2:2ND FLR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-1602
Mailing Address - Country:US
Mailing Address - Phone:718-684-4218
Mailing Address - Fax:
Practice Address - Street 1:2116 LACOMBE AVE
Practice Address - Street 2:2ND FLR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-1602
Practice Address - Country:US
Practice Address - Phone:718-684-4218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199953-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01271916Medicaid