Basic Information
| Provider Information | |||||||||
| NPI: | 1154794469 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAUREN C. RISPOLI,MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 573 BLOOMFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | VERONA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070441818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732394518 | ||||||||
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| Practice Location | |||||||||
| Address1: | 573 BLOOMFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | VERONA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070441818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732394518 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2015 | ||||||||
| LastUpdateDate: | 11/09/2015 | ||||||||
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| AuthorizedOfficialLastName: | RISPOLI | ||||||||
| AuthorizedOfficialFirstName: | LAUREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9736997928 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | MA56220 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.