Provider Demographics
NPI:1962589648
Name:LAST, LAURI STARK (DO)
Entity type:Individual
Prefix:DR
First Name:LAURI
Middle Name:STARK
Last Name:LAST
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 OLD BRITTON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-1723
Mailing Address - Country:US
Mailing Address - Phone:516-221-6338
Mailing Address - Fax:
Practice Address - Street 1:2857 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2018
Practice Address - Country:US
Practice Address - Phone:516-785-2783
Practice Address - Fax:516-785-2584
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1671222083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine