Provider Demographics
NPI:1033531504
Name:ROOP, LAUREN ELIZABETH (PA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:ROOP
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 BROADWAY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:10007-2056
Mailing Address - Country:US
Mailing Address - Phone:646-596-7386
Mailing Address - Fax:649-360-2739
Practice Address - Street 1:281 BROADWAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:10007-2056
Practice Address - Country:US
Practice Address - Phone:646-596-7386
Practice Address - Fax:649-360-2739
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016863363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant