Provider Demographics
NPI:1831336361
Name:DELLER, LAUREN (MS, LAC)
Entity type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:
Last Name:DELLER
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:WOLFERSBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2460 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6612
Mailing Address - Country:US
Mailing Address - Phone:646-369-9583
Mailing Address - Fax:718-981-3574
Practice Address - Street 1:2460 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6612
Practice Address - Country:US
Practice Address - Phone:646-369-9583
Practice Address - Fax:718-981-3574
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3982171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist