Individual
LAUREN A LOPERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
122 PORTION RD, RONKONKOMA, NY 11779-4174
(631) 588-6665
(631) 580-5543
Mailing address
122 PORTION RD, RONKONKOMA, NY 11779-4174
(631) 588-6665
(631) 580-5543
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
010551-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010551-01
NYS REGISTRATION CERTIFICATE
NY
Enumeration date
09/22/2008
Last updated
08/11/2022
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