Healthcare Provider Details

I. General information

NPI: 1295415735
Provider Name (Legal Business Name): LAUREN E OGNIBENE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 N 2ND ST APT 402
PHILADELPHIA PA
19106-1320
US

IV. Provider business mailing address

257 N 2ND ST APT 402
PHILADELPHIA PA
19106-1320
US

V. Phone/Fax

Practice location:
  • Phone: 609-744-1202
  • Fax:
Mailing address:
  • Phone: 609-744-1202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: