1154793263 NPI number — DR. LAWRENCE JOHN SEVERINO M.D.

Table of content: DR. LAWRENCE JOHN SEVERINO M.D. (NPI 1154793263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154793263 NPI number — DR. LAWRENCE JOHN SEVERINO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEVERINO
Provider First Name:
LAWRENCE
Provider Middle Name:
JOHN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SEVERINO
Provider Other First Name:
LAWRENCE
Provider Other Middle Name:
JOHN
Provider Other Name Prefix Text:
PROF.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1154793263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 SAXON WOODS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE PLAINS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10605-4821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-949-6344
Provider Business Mailing Address Fax Number:
914-948-5563

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 SAXON WOODS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE PLAINS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10605-4821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-949-6344
Provider Business Practice Location Address Fax Number:
914-948-5563
Provider Enumeration Date:
10/28/2015

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: 207V00000X , with the licence number:  90354 , 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)





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