Healthcare Provider Details

I. General information

NPI: 1750673166
Provider Name (Legal Business Name): LAUREN GOLDLUST OKON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 WHITE HORSE RD STE C103
VOORHEES NJ
08043-2461
US

IV. Provider business mailing address

833 CHESTNUT ST STE 740
PHILADELPHIA PA
19107-4409
US

V. Phone/Fax

Practice location:
  • Phone: 856-627-1900
  • Fax: 856-627-6907
Mailing address:
  • Phone: 215-955-6680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25MA10254800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: