Basic Information
Provider Information
NPI: 1386218238
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOLLENDER
FirstName: LAUREN
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 789 SAINT MARKS AVE APT 1C
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112131426
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1894 WALTON AVE
Address2:  
City: BRONX
State: NY
PostalCode: 104536018
CountryCode: US
TelephoneNumber: 7185833060
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/16/2021
LastUpdateDate: 09/10/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/10/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X729719NYN Nursing Service ProvidersRegistered Nurse 
363LF0000X348106NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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