Provider Demographics
NPI:1861115263
Name:ZEIDNER-RODRIGUEZ, LAUREN SUSANNA (NYCPS-P)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:SUSANNA
Last Name:ZEIDNER-RODRIGUEZ
Suffix:
Gender:F
Credentials:NYCPS-P
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:SUSANNA
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:445 OAK ST
Mailing Address - Street 2:
Mailing Address - City:COPIAGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11726-3111
Mailing Address - Country:US
Mailing Address - Phone:631-257-5173
Mailing Address - Fax:
Practice Address - Street 1:1056 W JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3212
Practice Address - Country:US
Practice Address - Phone:631-656-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYCPS-P-4980175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist