Provider Demographics
NPI:1518614049
Name:ALBURG, LAUREN MONIQUE
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MONIQUE
Last Name:ALBURG
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 1:71 FAIRLAWN DR
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-4692
Mailing Address - Country:US
Mailing Address - Phone:631-662-3433
Mailing Address - Fax:
Practice Address - Street 1:71 FAIRLAWN DR
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-4692
Practice Address - Country:US
Practice Address - Phone:631-662-3433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-04
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NY029719363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst