Provider Demographics
NPI:1538495205
Name:KELLER, LAUREN N (MS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:N
Last Name:KELLER
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:N
Other - Last Name:MORASSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PA-C
Mailing Address - Street 1:70 N COUNTRY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2161
Mailing Address - Country:US
Mailing Address - Phone:631-474-0707
Mailing Address - Fax:
Practice Address - Street 1:4271 HEMPSTEAD TPKE STE 1
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714
Practice Address - Country:US
Practice Address - Phone:516-796-3700
Practice Address - Fax:516-796-3205
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014103363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant