Basic Information
| Provider Information | |||||||||
| NPI: | 1679138663 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PINE | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 HOSPITAL RD STE 115 | ||||||||
| Address2: | |||||||||
| City: | EAST PATCHOGUE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117728811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312285801 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 HOSPITAL RD STE 115 | ||||||||
| Address2: | |||||||||
| City: | EAST PATCHOGUE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117728811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312285801 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2019 | ||||||||
| LastUpdateDate: | 08/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 316180 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | 316180 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.