Provider Demographics
NPI:1447515028
Name:PALLAY, LAUREN NICOLA
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:NICOLA
Last Name:PALLAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BETH DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-1206
Mailing Address - Country:US
Mailing Address - Phone:845-695-2993
Mailing Address - Fax:
Practice Address - Street 1:1751 RTE 17A
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:NY
Practice Address - Zip Code:10918
Practice Address - Country:US
Practice Address - Phone:845-651-2258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY304224539OtherDRIVERS LICENSE