Healthcare Provider Details

I. General information

NPI: 1639068356
Provider Name (Legal Business Name): LAUREN HADZIGEORGIOU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 BLUE POINT AVE
BLUE POINT NY
11715-1261
US

IV. Provider business mailing address

235 BLUE POINT AVE
BLUE POINT NY
11715-1261
US

V. Phone/Fax

Practice location:
  • Phone: 631-650-6545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: