Healthcare Provider Details

I. General information

NPI: 1497457535
Provider Name (Legal Business Name): LAUREN RADIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 FOREST AVE STE 110
PARAMUS NJ
07652-5246
US

IV. Provider business mailing address

PO BOX 3016
SOUTH HACKENSACK NJ
07606-1016
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-6678
  • Fax: 201-342-4346
Mailing address:
  • Phone: 201-488-6678
  • Fax: 201-342-4346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2185542
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: