Provider Demographics
NPI:1578865010
Name:KAISER, LAURA (RD, CDE)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:KAISER
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-1017
Mailing Address - Country:US
Mailing Address - Phone:917-453-2947
Mailing Address - Fax:
Practice Address - Street 1:1097 OLD COUNTRY RD STE 102
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-6505
Practice Address - Country:US
Practice Address - Phone:516-931-1007
Practice Address - Fax:516-931-1008
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006667133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered