Provider Demographics
NPI:1417200460
Name:MAROLA, LAUREN (PA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MAROLA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 LITTLE EAST NECK RD S
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3206
Mailing Address - Country:US
Mailing Address - Phone:631-559-6899
Mailing Address - Fax:
Practice Address - Street 1:500 MONTAUK HWY
Practice Address - Street 2:SUITE H
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4418
Practice Address - Country:US
Practice Address - Phone:631-422-9100
Practice Address - Fax:631-422-2411
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP86045363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical