Provider Demographics
NPI:1356992234
Name:MOYER, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MOYER
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 1:65 HARRISTOWN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-3317
Mailing Address - Country:US
Mailing Address - Phone:201-487-1240
Mailing Address - Fax:201-487-1241
Practice Address - Street 1:65 HARRISTOWN RD STE 101
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-3317
Practice Address - Country:US
Practice Address - Phone:201-487-1240
Practice Address - Fax:201-487-1241
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00964300363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health