Provider Demographics
NPI:1376094805
Name:HARTMAN, LAUREN (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:HARTMAN
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 1:420 FRONT ST
Mailing Address - Street 2:PO BOX 578
Mailing Address - City:ELMER
Mailing Address - State:NJ
Mailing Address - Zip Code:08318-2177
Mailing Address - Country:US
Mailing Address - Phone:856-358-1500
Mailing Address - Fax:856-358-6985
Practice Address - Street 1:420 FRONT ST
Practice Address - Street 2:
Practice Address - City:ELMER
Practice Address - State:NJ
Practice Address - Zip Code:08318-2177
Practice Address - Country:US
Practice Address - Phone:856-358-1500
Practice Address - Fax:856-358-6985
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00413100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ541730VY2Medicare PIN