Provider Demographics
NPI:1023342003
Name:POLITO, LAURA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:POLITO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:BURRIESCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8909 BAY 16TH ST APT B1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-5923
Mailing Address - Country:US
Mailing Address - Phone:347-628-8862
Mailing Address - Fax:
Practice Address - Street 1:256 MASON AVE
Practice Address - Street 2:BUILDING B- 2ND FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3408
Practice Address - Country:US
Practice Address - Phone:718-226-1271
Practice Address - Fax:718-226-1247
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013497363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical