Active NPI
Lauren Kendall Smith, PA-C
- Physician Assistant
- Hackensack, NJ
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 25MP00724200
- Practice address
- 30 Prospect Ave
Wfan BLDG Pc218
Hackensack, NJ 07601 - Phone
- (551) 996-5362
- Fax
- (551) 996-3232
- NPI assigned
- Jun 11, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 4123 | CT | |
| Physician Assistant | 363A00000X | 25MP00724200 | NJ | Primary |
Addresses
Primary practice location
30 Prospect Ave
Wfan BLDG Pc218
Hackensack, NJ 07601
Mailing address
21 Laurelwood Dr
Mountain Lakes, NJ 07046-1732
Phone (973) 476-2909
Other practice location 1
24 Hospital Ave
Danbury, CT 06810
Phone (203) 739-7000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT, NJ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MP00724200 | NJ | MD | Physician Assistant |
| 4123 | CT | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hackensack Meridian Health Medical Group - Specialty Care PC | Current | Accepting new patients | |
| Connecticut Children'S Specialty Group, Inc. | Physician Assistant | Current | Accepting new patients |
| Hackensack Meridian Health Medical Group - Complex Care PC | Past | Accepting new patients |
Locations
24 Hospital Ave
Danbury, CT 06810
Phone (203) 739-7118
10 Columbus Blvd
Hartford, CT 06106
Phone (860) 837-5619
282 Washington St
Hartford, CT 06106
Phone (860) 545-8950
10 Columbus Blvd
Fl 4
Hartford, CT 06106
Phone (860) 837-5560
30 Prospect Ave
Hackensack, NJ 07601
Phone (201) 488-0066
30 Prospect Ave
Bldg PC218
Hackensack, NJ 07601
Phone (551) 996-5362
Interoperability endpoints
- lsmith41388@connecticutchildrens.direct-ci.com
- https://fhir4.healow.com/fhir/r4/IHJHBD
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatrics Physician
- Hartford, CT
- NPI 1669448882
Physician Assistant
-
- Surgical Critical Care Physician
- Red Bank, NJ
- NPI 1215989249
-
- Durable Medical Equipment & Medical Supplies
- North Bergen, NJ
- NPI 1215734199
-
- Internal Medicine Physician
- Red Bank, NJ
- NPI 1154379626
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670284800000",
"number": "1952894339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 LAURELWOOD DR",
"city": "MOUNTAIN LAKES",
"state": "NJ",
"postal_code": "070461732",
"telephone_number": "973-476-2909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 PROSPECT AVE",
"address_2": "WFAN BLDG PC218",
"city": "HACKENSACK",
"state": "NJ",
"postal_code": "07601",
"telephone_number": "551-996-5362",
"fax_number": "551-996-3232"
}
],
"practiceLocations": [
{
"address_1": "24 Hospital Ave",
"address_purpose": "LOCATION",
"city": "Danbury",
"state": "CT",
"postal_code": "06810",
"country_code": "US",
"telephone_number": "203-739-7000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SMITH",
"first_name": "LAUREN",
"middle_name": "KENDALL",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-11",
"last_updated": "2022-12-06",
"certification_date": "2022-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CT",
"license": "4123",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NJ",
"license": "25MP00724200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Hackensack, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.