Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 0461291 | NY |
Y | 213EG0000X | General Practice | 0461291 | NY |
NPI | 1003072182 |
---|---|
Provider Name | Ekaterini Laoutoris |
First Address | Newburgh, NY 12550-5514 |
Second Address | Newburgh, NY 12550-5514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2008 |
Last Update Date | 29/07/2008 |