Provider Demographics
NPI:1104528579
Name:GITELSON, LAUREN
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:GITELSON
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 1:11 STRATTON LN
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3213
Mailing Address - Country:US
Mailing Address - Phone:631-974-2573
Mailing Address - Fax:
Practice Address - Street 1:11 STRATTON LN
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3213
Practice Address - Country:US
Practice Address - Phone:631-974-2573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator