Healthcare Provider Details

I. General information

NPI: 1225333271
Provider Name (Legal Business Name): LAUREN ERICA RADZIEJEWSKI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 BROADWAY PH
NEW YORK NY
10012-2614
US

IV. Provider business mailing address

632 BROADWAY PH
NEW YORK NY
10012-2614
US

V. Phone/Fax

Practice location:
  • Phone: 347-933-6246
  • Fax: 855-318-8277
Mailing address:
  • Phone: 347-933-6246
  • Fax: 855-318-8277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR1996443
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF308896
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: