MEDICARE: LAUREN ANGIOLETTI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207WX0107X	Retina Specialist (Ophthalmology) Physician	25MA06413000	NJ
2	207W00000X	Ophthalmology Physician	25MA06413000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023017357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN ANGIOLETTI M.D.

Provider Business Mailing Address
First Line	:	1 CORPORATE DR
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-3112
Country	:	US
Telephone Number	:	973-987-3380
Fax Number	:	973-987-3379

Provider Business Practice Location Address
First Line	:	1255 BROAD ST
Second Line	:	STE 104
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-3000
Country	:	US
Telephone Number	:	973-707-5632
Fax Number	:	973-707-7349

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	11/28/2023

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