Individual
LAUREN DIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
44 ROUTE 23 NORTH, SUITE 213, RIVERDALE, NJ 07457
(973) 571-2121
Mailing address
85 TREMONT TER, WANAQUE, NJ 07465-1117
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
015171
NY
363A00000X
Physician Assistant
Primary
25MP00277100
NJ
Other
Enumeration date
12/20/2011
Last updated
01/22/2012
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