Provider Demographics
NPI:1780115246
Name:MATERA, LAUREN (DO)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MATERA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SAW MILL RIVER RD
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-1535
Mailing Address - Country:US
Mailing Address - Phone:914-304-5288
Mailing Address - Fax:914-345-1755
Practice Address - Street 1:40 SAW MILL RIVER RD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-1535
Practice Address - Country:US
Practice Address - Phone:914-304-5288
Practice Address - Fax:914-345-1755
Is Sole Proprietor?:No
Enumeration Date:2017-03-25
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.008380208000000X
390200000X
NY3223542080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program