Provider Demographics
NPI:1679099139
Name:CLOSS, EMILIA LAURA (BA, MSED)
Entity type:Individual
Prefix:MISS
First Name:EMILIA
Middle Name:LAURA
Last Name:CLOSS
Suffix:
Gender:F
Credentials:BA, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 PRAIRIE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-1104
Mailing Address - Country:US
Mailing Address - Phone:631-942-7616
Mailing Address - Fax:
Practice Address - Street 1:255 EXECUTIVE DR STE LL105108
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1718
Practice Address - Country:US
Practice Address - Phone:516-576-2040
Practice Address - Fax:516-576-2131
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist