Provider Demographics
NPI:1609204239
Name:HERTWIG, LAUREN ALISON (NP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ALISON
Last Name:HERTWIG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 AMYS PATH
Mailing Address - Street 2:
Mailing Address - City:EAST QUOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11942-4131
Mailing Address - Country:US
Mailing Address - Phone:631-872-3788
Mailing Address - Fax:631-206-9299
Practice Address - Street 1:21 E 2ND ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-4686
Practice Address - Country:US
Practice Address - Phone:631-873-9257
Practice Address - Fax:631-206-9299
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401648-1363LP0808X
NY351210363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health