Provider Demographics
NPI:1154758969
Name:LAUREN MINCHEN NUTRITION
Entity type:Organization
Organization Name:LAUREN MINCHEN NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:MINCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDN
Authorized Official - Phone:646-745-7034
Mailing Address - Street 1:280 MADISON AVE RM 806
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0805
Mailing Address - Country:US
Mailing Address - Phone:646-745-7034
Mailing Address - Fax:
Practice Address - Street 1:280 MADISON AVE RM 806
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0805
Practice Address - Country:US
Practice Address - Phone:646-745-7034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1049273261QM2500X
NY007792-1261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1902157118OtherNPI