Individual
MRS. LAURA E BALSAMO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4 LARRY CT, MANORVILLE, NY 11949-2833
(631) 772-2789
Mailing address
4 LARRY CT, MANORVILLE, NY 11949-2833
(631) 772-2789
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
NY
Other
Enumeration date
11/03/2015
Last updated
07/21/2022
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