Provider Demographics
NPI:1003524257
Name:HENDRICK STAHLSMITH, LAUREN CATHERINE (PA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:CATHERINE
Last Name:HENDRICK STAHLSMITH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:CATHERINE
Other - Last Name:HENDRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:300 E 57TH ST APT 2H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2994
Mailing Address - Country:US
Mailing Address - Phone:716-490-2763
Mailing Address - Fax:
Practice Address - Street 1:99 PARK AVE FL 20
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1601
Practice Address - Country:US
Practice Address - Phone:212-972-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028799363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant