Provider Demographics
NPI:1649273202
Name:DECKER, LAURA J (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:J
Last Name:DECKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WEST BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477
Mailing Address - Country:US
Mailing Address - Phone:845-246-3000
Mailing Address - Fax:845-246-7622
Practice Address - Street 1:16 W BRIDGE ST
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-1415
Practice Address - Country:US
Practice Address - Phone:845-246-3000
Practice Address - Fax:845-246-7622
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195667-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10031712OtherCDPHP
LD06883010OtherEMPIRE BLUE CROSS
080117483OtherRAILROAD MEDICARE
215424OtherWELLCARE
NY087231OtherMVP
69117OtherGHI HMO
NY01674235Medicaid
688304L301Medicare PIN
NYG40819Medicare UPIN
NY01674235Medicaid