Healthcare Provider Details

I. General information

NPI: 1710468749
Provider Name (Legal Business Name): LAUREN R BAMBARA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 STATE ROUTE 33
NEPTUNE NJ
07753-4859
US

IV. Provider business mailing address

205 BEVERLY WAY
NEPTUNE NJ
07753-5710
US

V. Phone/Fax

Practice location:
  • Phone: 732-776-4203
  • Fax:
Mailing address:
  • Phone: 732-241-1269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00715500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: