Provider Demographics
NPI:1356335640
Name:MONAHAN, LAURA J (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:MONAHAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:100 NICOLLS RD
Mailing Address - Street 2:LEVEL 11, SUITE 040
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8111
Mailing Address - Country:US
Mailing Address - Phone:631-444-2725
Mailing Address - Fax:631-444-2894
Practice Address - Street 1:100 NICOLLS RD
Practice Address - Street 2:LEVEL 11, SUITE 040
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8111
Practice Address - Country:US
Practice Address - Phone:631-444-2725
Practice Address - Fax:631-444-2894
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2014-02-07
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Provider Licenses
StateLicense IDTaxonomies
NY2059322080P0203X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01970474Medicaid
NYH70438Medicare UPIN
NY23R211Medicare ID - Type Unspecified