Provider Demographics
NPI:1437788197
Name:KNOCKER, LAUREN
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:
Last Name:KNOCKER
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 1:11 STEPHENS CT
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4735
Mailing Address - Country:US
Mailing Address - Phone:631-624-1301
Mailing Address - Fax:
Practice Address - Street 1:11 STEPHENS CT
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4735
Practice Address - Country:US
Practice Address - Phone:631-624-1301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-05
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025451363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant