Provider Demographics
NPI:1720096787
Name:MARQUIS-DUSAUZAY, LAURA (DPM)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:MARQUIS-DUSAUZAY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 ASHFORD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207
Mailing Address - Country:US
Mailing Address - Phone:718-927-4216
Mailing Address - Fax:
Practice Address - Street 1:593 ASHFORD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207
Practice Address - Country:US
Practice Address - Phone:718-927-4216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004415213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01082755Medicaid
NY01082755Medicaid
480017342Medicare PIN
NYP45981Medicare PIN
NY02282Medicare PIN