Healthcare Provider Details

I. General information

NPI: 1992164602
Provider Name (Legal Business Name): LAUREN DEMARCO APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2016
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 NORTHLEA DR
BOONTON NJ
07005-9519
US

IV. Provider business mailing address

16 POCONO RD STE 110
DENVILLE NJ
07834-2905
US

V. Phone/Fax

Practice location:
  • Phone: 862-812-0771
  • Fax:
Mailing address:
  • Phone: 973-586-3700
  • Fax: 973-586-8666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00621800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: