1780068221 NPI number — MRS. LAUREN E LAVINE NP

Table of content: MRS. LAUREN E LAVINE NP (NPI 1780068221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780068221 NPI number — MRS. LAUREN E LAVINE NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAVINE
Provider First Name:
LAUREN
Provider Middle Name:
E
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GILDEMEYER
Provider Other First Name:
LAUREN
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780068221
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6846 BUCKLEY ROAD
Provider Second Line Business Mailing Address:
NEPHROLOGY HYPERTENSION ASSOCIATES OF CNY, PC
Provider Business Mailing Address City Name:
NORTH SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-410-6400
Provider Business Mailing Address Fax Number:
315-410-6410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6846 BUCKLEY ROAD
Provider Second Line Business Practice Location Address:
NEPHROLOGY HYPERTENSION ASSOCIATES OF CNY, PC
Provider Business Practice Location Address City Name:
NORTH SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-410-6400
Provider Business Practice Location Address Fax Number:
315-410-6410
Provider Enumeration Date:
07/15/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  339783 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)