Healthcare Provider Details

I. General information

NPI: 1538422845
Provider Name (Legal Business Name): LAUREN JEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 VAN CORTLANDT PARK E
BRONX NY
10470-1875
US

IV. Provider business mailing address

4350 VAN CORTLANDT PARK E
BRONX NY
10470-1875
US

V. Phone/Fax

Practice location:
  • Phone: 718-231-6565
  • Fax:
Mailing address:
  • Phone: 718-231-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT201624
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number283344
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: