Provider Demographics
NPI:1750339271
Name:AMRAM, LAURA (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:AMRAM
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 1:7349 188TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1727
Mailing Address - Country:US
Mailing Address - Phone:347-552-9313
Mailing Address - Fax:
Practice Address - Street 1:7158 AUSTIN ST
Practice Address - Street 2:STE 102
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4735
Practice Address - Country:US
Practice Address - Phone:347-552-9313
Practice Address - Fax:646-924-3223
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2377202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY237720OtherLICENSE
NYI65524Medicare UPIN