Provider Demographics
NPI:1376787747
Name:GUCCIARDI, LAUREN M
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:M
Last Name:GUCCIARDI
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 1:256 MASON AVE BLDG B
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3408
Mailing Address - Country:US
Mailing Address - Phone:718-226-6790
Mailing Address - Fax:718-226-7950
Practice Address - Street 1:256 MASON AVE
Practice Address - Street 2:BUILDING C
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3408
Practice Address - Country:US
Practice Address - Phone:718-226-6400
Practice Address - Fax:718-226-6404
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009157363A00000X
NY009157-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant