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General NPI Number Information
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NPI Number | 1063861144
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Entity Type | Individual
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Provider Name | LAUREN ASHLEY ROYCE PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 02/11/2020
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Provider Practice Location Address
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Address Line | 1135 BROAD STREET SUITE 1
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City | CLIFTON
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State | NJ
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Zip | 07013
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Country | US
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Telephone | 973-754-2315
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Fax | 973-754-2925
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Provider Business Mailing Address
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Address Line | 754 VALLEY RD
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City | WAYNE
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State | NJ
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Zip | 07470-3454
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 25MP00405000
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License Number State | NJ
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