1114913720 NPI number — MR. JEFFREY R LAWRENCE MSW

Table of content: MR. JEFFREY R LAWRENCE MSW (NPI 1114913720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114913720 NPI number — MR. JEFFREY R LAWRENCE MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWRENCE
Provider First Name:
JEFFREY
Provider Middle Name:
R
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114913720
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
949 CENTRAL AVE
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
WOODMERE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11598-1204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-374-1360
Provider Business Mailing Address Fax Number:
516-536-0313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
949 CENTRAL AVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
WOODMERE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11598-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-374-1360
Provider Business Practice Location Address Fax Number:
516-536-0313
Provider Enumeration Date:
09/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  PR007430-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: R007430 . This is a "HIP PROVIDER #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0054754 . This is a "GHI PROVIDER#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com