=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407789480
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN NICOLE RENNA PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2026
-----------------------------------------------------
Last Update Date | 06/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 CODDINGTON LN
-----------------------------------------------------
City | CALIFON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07830-3440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-432-6008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 CODDINGTON LN
-----------------------------------------------------
City | CALIFON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07830-3440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-432-6008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------