Healthcare Provider Details

I. General information

NPI: 1023017357
Provider Name (Legal Business Name): LAUREN ANGIOLETTI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 BROAD ST STE 104
BLOOMFIELD NJ
07003-3000
US

IV. Provider business mailing address

1 CORPORATE DR
WAYNE NJ
07470-3112
US

V. Phone/Fax

Practice location:
  • Phone: 973-707-5632
  • Fax: 973-707-7349
Mailing address:
  • Phone: 973-987-3380
  • Fax: 973-987-3379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25MA06413000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number25MA06413000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: