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General NPI Number Information
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NPI Number | 1700413754
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Entity Type | Individual
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Provider Name | LAUREN MORDUKHAEV MD
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Gender | Female
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 680 AMERICAN AVENUE SUITE 302 (PRIVATE OFFICE 322)
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406
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Country | US
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Telephone | 833-351-8255
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 24449
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City | NEW YORK
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State | NY
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Zip | 10087-0589
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Country | US
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Telephone | 833-351-8255
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Fax | 888-815-3583
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD491365
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 337487
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License Number State | NY
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