Provider Demographics
NPI:1366706756
Name:BRIDA, LAUREN M
Entity type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:M
Last Name:BRIDA
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 1:210 N SUFFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:N MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-3334
Mailing Address - Country:US
Mailing Address - Phone:516-698-8270
Mailing Address - Fax:
Practice Address - Street 1:210 N SUFFOLK AVE
Practice Address - Street 2:
Practice Address - City:N MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-3334
Practice Address - Country:US
Practice Address - Phone:516-698-8270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist