Provider Demographics
NPI:1235768938
Name:COFFUA, LAUREN SUSAN (DO, MS)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:SUSAN
Last Name:COFFUA
Suffix:
Gender:F
Credentials:DO, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 W SHERMAN AVE BLDG 2A
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6911
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1206 W SHERMAN AVE BLDG 2A
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6911
Practice Address - Country:US
Practice Address - Phone:856-696-9933
Practice Address - Fax:856-696-9939
Is Sole Proprietor?:No
Enumeration Date:2020-04-04
Last Update Date:2025-06-17
Deactivation Date:2024-03-28
Deactivation Code:
Reactivation Date:2024-04-03
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MB12115900208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program