Basic Information
| Provider Information | |||||||||
| NPI: | 1083665608 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LASTER | ||||||||
| FirstName: | AVI | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 651 W MOUNT PLEASANT AVE | ||||||||
| Address2: | |||||||||
| City: | LIVINGSTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070391600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732511086 | ||||||||
| FaxNumber: | 9732511109 | ||||||||
| Practice Location | |||||||||
| Address1: | 160 N MIDLAND AVE | ||||||||
| Address2: | |||||||||
| City: | NYACK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109601912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456850487 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 08/04/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 008653 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.