Basic Information
| Provider Information | |||||||||
| NPI: | 1003801259 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RISPOLI | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 46 EAGLE ROCK AVE | ||||||||
| Address2: | |||||||||
| City: | EAST HANOVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079363104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9735601500 | ||||||||
| FaxNumber: | 9735600419 | ||||||||
| Practice Location | |||||||||
| Address1: | VERONA OPTICIANS | ||||||||
| Address2: | 573 BLOOMFIELD AVE | ||||||||
| City: | VERONA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070441818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732394518 | ||||||||
| FaxNumber: | 9732396210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2005 | ||||||||
| LastUpdateDate: | 07/12/2018 | ||||||||
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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 | 207W00000X | MA056220 | NJ | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 5570301 | 05 | NJ | MEDICAID |