Provider Demographics
NPI:1275971012
Name:GOLDMAN, LAUREN (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 WESTCHESTER AVE
Mailing Address - Street 2:MEDICAL OFFICE
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-3525
Mailing Address - Country:US
Mailing Address - Phone:914-253-2770
Mailing Address - Fax:914-253-3557
Practice Address - Street 1:1111 WESTCHESTER AVE
Practice Address - Street 2:MEDICAL OFFICE
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-3525
Practice Address - Country:US
Practice Address - Phone:914-253-2770
Practice Address - Fax:914-253-3557
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004249363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004249OtherNYS LICENSE NUMBER