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General NPI Number Information
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NPI Number | 1821423674
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Entity Type | Individual
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Provider Name | LAUREN TABLEMAN PMHNP
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Gender | Female
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Dates
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Enumeration Date | 09/12/2013
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Last Update Date | 12/09/2022
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Provider Practice Location Address
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Address Line | 9 SHILOH CT
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City | CORAM
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State | NY
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Zip | 11727-1642
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Country | US
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Telephone | 631-291-3337
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Fax |
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Provider Business Mailing Address
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Address Line | 991 MAIN ST STE 201
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City | HOLBROOK
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State | NY
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Zip | 11741-1608
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Country | US
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Telephone | 631-364-2647
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Fax | 631-350-0584
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 404303-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 654232-1
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License Number State | NY
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