Basic Information
| Provider Information | |||||||||
| NPI: | 1336173608 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VIGNA | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MEIERHANS | ||||||||
| OtherFirstName: | LAUREN | ||||||||
| OtherMiddleName: | R | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 222 ROUTE 299. | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456913627 | ||||||||
| FaxNumber: | 8456913641 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 ROUTE 299. | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456913627 | ||||||||
| FaxNumber: | 8456913641 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 10/23/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 217325 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02151935 | 05 | NY | MEDICAID |