Provider Demographics
NPI:1003801259
Name:RISPOLI, LAUREN G (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:G
Last Name:RISPOLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:46 EAGLE ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-3104
Mailing Address - Country:US
Mailing Address - Phone:973-560-1500
Mailing Address - Fax:973-560-0419
Practice Address - Street 1:VERONA OPTICIANS
Practice Address - Street 2:573 BLOOMFIELD AVE
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1818
Practice Address - Country:US
Practice Address - Phone:973-239-4518
Practice Address - Fax:973-239-6210
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA056220207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5570301Medicaid
NJ5570301Medicaid