Healthcare Provider Details

I. General information

NPI: 1982921888
Provider Name (Legal Business Name): LAUREN BLACKWELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2010
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BERGEN ST ROOM I-248
NEWARK NJ
07103-2496
US

IV. Provider business mailing address

150 BERGEN ST ROOM I-248
NEWARK NJ
07103-2496
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-6056
  • Fax: 973-972-3129
Mailing address:
  • Phone: 973-972-6056
  • Fax: 973-972-3129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number286735
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number286735
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: