Doctor Name: | MS. JODI LASKY |
NPI Number: | 1003188814 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 001139 |
Business Practice Address: | 26 Westport Dr Waterbury, CT - 067062854 |
Business Phone Number: | 2035654728 |
Business Fax Number: | |
Mailing Address: | 26 Westport Dr, WATERBURY |
State: | CT |
Postal Code: | 067062854 |
Phone Number: | 2035654728 |
Fax Number: | |
NPI Enumeration Date: | 02/09/2012 |
NPI Last Update Date: | 07/31/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 001139 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |