=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003801259
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN G RISPOLI MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2005
-----------------------------------------------------
Last Update Date | 11/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | VERONA OPTICIANS 573 BLOOMFIELD AVE
-----------------------------------------------------
City | VERONA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07044-1818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-239-4518
-----------------------------------------------------
Fax | 973-239-6210
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 46 EAGLE ROCK AVE
-----------------------------------------------------
City | EAST HANOVER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07936-3104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-560-1500
-----------------------------------------------------
Fax | 973-560-0419
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | MA056220
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 25MA5622000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------