Healthcare Provider Details

I. General information

NPI: 1780115246
Provider Name (Legal Business Name): LAUREN MATERA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2017
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 SAW MILL RIVER RD
HAWTHORNE NY
10532-1535
US

IV. Provider business mailing address

40 SAW MILL RIVER RD
HAWTHORNE NY
10532-1535
US

V. Phone/Fax

Practice location:
  • Phone: 914-304-5288
  • Fax: 914-345-1755
Mailing address:
  • Phone: 914-304-5288
  • Fax: 914-345-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number58.008380
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number322354
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: