Provider Demographics
NPI:1467474221
Name:ROBERTS, LAUREN (DC)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 MANHATTAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-2989
Mailing Address - Country:US
Mailing Address - Phone:718-389-0953
Mailing Address - Fax:718-349-6968
Practice Address - Street 1:715 MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-2989
Practice Address - Country:US
Practice Address - Phone:718-389-0953
Practice Address - Fax:718-349-6968
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX3832111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT52583Medicare UPIN