Provider Demographics
NPI:1285187633
Name:DIERLAM, LAUREN ROSE (PA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ROSE
Last Name:DIERLAM
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:7385 S BROADWAY
Mailing Address - Street 2:# 2
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571-1745
Mailing Address - Country:US
Mailing Address - Phone:914-772-4656
Mailing Address - Fax:
Practice Address - Street 1:7385 S BROADWAY # 2
Practice Address - Street 2:
Practice Address - City:RED HOOK
Practice Address - State:NY
Practice Address - Zip Code:12571-1745
Practice Address - Country:US
Practice Address - Phone:845-758-1456
Practice Address - Fax:845-758-9590
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2019-02-27
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical