Provider Demographics
NPI:1336173608
Name:VIGNA, LAUREN RENEE (MD)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:RENEE
Last Name:VIGNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:R
Other - Last Name:MEIERHANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:222 ROUTE 299.
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528
Mailing Address - Country:US
Mailing Address - Phone:845-691-3627
Mailing Address - Fax:845-691-3641
Practice Address - Street 1:222 ROUTE 299.
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528
Practice Address - Country:US
Practice Address - Phone:845-691-3627
Practice Address - Fax:845-691-3641
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02151935Medicaid
NY0D3601Medicare PIN
NY02151935Medicaid
H26511Medicare UPIN