Provider Demographics
NPI:1346525011
Name:WEGGE, LAUREN P
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:P
Last Name:WEGGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 SUNRISE HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2950
Mailing Address - Country:US
Mailing Address - Phone:516-887-3516
Mailing Address - Fax:516-887-0331
Practice Address - Street 1:777 SUNRISE HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2950
Practice Address - Country:US
Practice Address - Phone:516-887-3516
Practice Address - Fax:516-887-0331
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015227363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical