Provider Demographics
NPI:1497222129
Name:BERMAN, LAUREN PATRICIA
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:PATRICIA
Last Name:BERMAN
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:P.O. BOX 1725
Mailing Address - Street 2:18 POST FIELDS LANE
Mailing Address - City:QUOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11959
Mailing Address - Country:US
Mailing Address - Phone:631-902-4912
Mailing Address - Fax:
Practice Address - Street 1:800 MONTAUK HWY STE 18
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-2128
Practice Address - Country:US
Practice Address - Phone:631-772-4646
Practice Address - Fax:631-772-2495
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant