Provider Demographics
NPI:1427033356
Name:CANOVA, LAUREN M (PA)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:M
Last Name:CANOVA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:M
Other - Last Name:GARETANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:9 PROFESSIONAL CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2427
Mailing Address - Country:US
Mailing Address - Phone:732-431-1520
Mailing Address - Fax:732-431-1567
Practice Address - Street 1:9 PROFESSIONAL CIRCLE
Practice Address - Street 2:SUITE 101
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2427
Practice Address - Country:US
Practice Address - Phone:732-431-1520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010022363AM0700X
NJ25MP000305900363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02634811Medicaid
NY02634811Medicaid