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General NPI Number Information
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NPI Number | 1689203606
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Entity Type | Individual
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Provider Name | LAUREN I KRZOS
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Gender | Female
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Dates
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Enumeration Date | 04/02/2020
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Last Update Date | 01/29/2023
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Provider Practice Location Address
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Address Line | 550 BROADWAY
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City | MASSAPEQUA
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State | NY
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Zip | 11758-5013
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Country | US
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Telephone | 516-809-9666
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Fax | 516-809-9665
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Provider Business Mailing Address
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Address Line | 550 BROADWAY
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City | MASSAPEQUA
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State | NY
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Zip | 11758-5013
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Country | US
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Telephone | 516-809-9666
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Fax | 516-809-9665
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 026022
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License Number State | NY
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