Healthcare Provider Details

I. General information

NPI: 1710362728
Provider Name (Legal Business Name): LAUREN IARROBINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 BROADWAY
AMITYVILLE NY
11701-2719
US

IV. Provider business mailing address

333 BROADWAY
AMITYVILLE NY
11701-2719
US

V. Phone/Fax

Practice location:
  • Phone: 631-789-2020
  • Fax: 631-789-5669
Mailing address:
  • Phone: 631-789-2020
  • Fax: 631-789-5669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF306671-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: