Provider Demographics
NPI:1457669178
Name:MONTEMAYOR, LAUREN M (PA)
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:M
Last Name:MONTEMAYOR
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 1:7511 198TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1820
Mailing Address - Country:US
Mailing Address - Phone:347-225-2965
Mailing Address - Fax:
Practice Address - Street 1:7511 198TH ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1820
Practice Address - Country:US
Practice Address - Phone:347-225-2965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1093749363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant