Provider Demographics
NPI:1285668889
Name:CERULLO, LAUREN (MPT)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:
Last Name:CERULLO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:DOWD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:162 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-1043
Mailing Address - Country:US
Mailing Address - Phone:201-741-6935
Mailing Address - Fax:
Practice Address - Street 1:77 NEWARK AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-4143
Practice Address - Country:US
Practice Address - Phone:201-759-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA10818225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ074170RGNMedicare ID - Type Unspecified