Healthcare Provider Details

I. General information

NPI: 1093095556
Provider Name (Legal Business Name): LAUREN KOCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2011
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BEAUVOIR AVE BOX 270
SUMMIT NJ
07901-3533
US

IV. Provider business mailing address

18 CRESCENT PL
SHORT HILLS NJ
07078-3411
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-5963
  • Fax:
Mailing address:
  • Phone: 513-313-8099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: