Provider Demographics
NPI:1861191389
Name:EPPIG, LAUREN NICOLE
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:NICOLE
Last Name:EPPIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406A N COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-1705
Mailing Address - Country:US
Mailing Address - Phone:631-860-8414
Mailing Address - Fax:
Practice Address - Street 1:406A N COUNTRY RD
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-1705
Practice Address - Country:US
Practice Address - Phone:631-860-8414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2768256174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist