Healthcare Provider Details

I. General information

NPI: 1417735200
Provider Name (Legal Business Name): LAUREN WILDMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 NJ-33
NEPTUNE NJ
07753
US

IV. Provider business mailing address

51 E END AVE
NEPTUNE CITY NJ
07753-6208
US

V. Phone/Fax

Practice location:
  • Phone: 732-775-5500
  • Fax:
Mailing address:
  • Phone: 201-783-4316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00808600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: