Provider Demographics
NPI:1235942137
Name:SCANLON, LAURA LILLIAN
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LILLIAN
Last Name:SCANLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 10TH AVE APT 4D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-7709
Mailing Address - Country:US
Mailing Address - Phone:570-604-3561
Mailing Address - Fax:
Practice Address - Street 1:818 10TH AVE APT 4D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-7709
Practice Address - Country:US
Practice Address - Phone:570-604-3561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist