Provider Demographics
NPI:1487018982
Name:SCHAEFER, LAUREN B
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:B
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:B
Other - Last Name:FLYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3785 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3827
Mailing Address - Country:US
Mailing Address - Phone:917-306-9800
Mailing Address - Fax:
Practice Address - Street 1:1535 RICHMOND AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1520
Practice Address - Country:US
Practice Address - Phone:718-556-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY727392131390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program