Provider Demographics
NPI:1023017357
Name:ANGIOLETTI, LAUREN (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:ANGIOLETTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3112
Mailing Address - Country:US
Mailing Address - Phone:973-987-3380
Mailing Address - Fax:973-987-3379
Practice Address - Street 1:1255 BROAD ST
Practice Address - Street 2:STE 104
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3000
Practice Address - Country:US
Practice Address - Phone:973-707-5632
Practice Address - Fax:973-707-7349
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06413000207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7161204Medicaid
NJG30502Medicare UPIN
NJ7161204Medicaid
NJ879197Medicare PIN
NJ1C1935OtherHEALTHNET INSURANCE CO.
NJ497576OtherAETNA INSURANCE CO.
NY864924OtherAETNA INSURANCE CO.
NY10729244Medicaid
NY90T90100Medicare PIN