Provider Demographics
NPI:1730150996
Name:MAZA, LAUREN (MD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MAZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ROUTE 9 N
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-1215
Mailing Address - Country:US
Mailing Address - Phone:732-634-0036
Mailing Address - Fax:732-855-9395
Practice Address - Street 1:1000 ROUTE 9 N
Practice Address - Street 2:SUITE 302
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-1215
Practice Address - Country:US
Practice Address - Phone:732-634-0036
Practice Address - Fax:732-855-9395
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA66813207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
582000OtherAETNA
K5407OtherHORIZON BLUE SHIELD
1377907OtherUNITED HEALTH CARE
NJ8222401Medicaid
K5407OtherHORIZON BLUE SHIELD
MA005133Medicare ID - Type Unspecified