Provider Demographics
NPI:1871219568
Name:PERUSO, LAUREN EILEEN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:EILEEN
Last Name:PERUSO
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 1:7715 LAWNTON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-3105
Mailing Address - Country:US
Mailing Address - Phone:845-325-4727
Mailing Address - Fax:
Practice Address - Street 1:704 W NIELDS ST STE 4-5
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-4102
Practice Address - Country:US
Practice Address - Phone:610-431-2008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK0011365171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty