Provider Demographics
NPI:1245810159
Name:KRAVITZ, LAUREN (ATC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:KRAVITZ
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 HOBOKEN RD
Mailing Address - Street 2:
Mailing Address - City:EAST RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07073-1304
Mailing Address - Country:US
Mailing Address - Phone:201-527-8298
Mailing Address - Fax:
Practice Address - Street 1:252 HOBOKEN RD
Practice Address - Street 2:
Practice Address - City:EAST RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07073-1304
Practice Address - Country:US
Practice Address - Phone:201-527-8298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001911002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer