Provider Demographics
NPI:1194068353
Name:WAMP, LAUREN P
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:P
Last Name:WAMP
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 1:17 CROSSWAY DR
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-6224
Mailing Address - Country:US
Mailing Address - Phone:347-860-3287
Mailing Address - Fax:
Practice Address - Street 1:17 CROSSWAY DR
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-6224
Practice Address - Country:US
Practice Address - Phone:347-860-3287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1087669174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist