Provider Demographics
NPI:1396700100
Name:VITOLO, LAUREN A (MS,PA-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:A
Last Name:VITOLO
Suffix:
Gender:F
Credentials:MS,PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 COLUMBIA TPKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2283
Mailing Address - Country:US
Mailing Address - Phone:973-736-9535
Mailing Address - Fax:973-736-2607
Practice Address - Street 1:128 COLUMBIA TPKE
Practice Address - Street 2:SUITE 200
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2283
Practice Address - Country:US
Practice Address - Phone:973-736-9535
Practice Address - Fax:973-736-2607
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00125000363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223777703OtherCOMMERCIAL INSURANCES
NJ097468BQHMedicare PIN
NJQ62639Medicare UPIN