Provider Demographics
NPI:1003832437
Name:NESHIWAT, LAWRENCE FAYEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:FAYEZ
Last Name:NESHIWAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1019 YONKERS AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-3034
Mailing Address - Country:US
Mailing Address - Phone:914-237-1941
Mailing Address - Fax:914-237-1950
Practice Address - Street 1:944 N BROADWAY
Practice Address - Street 2:SUITE 205
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1304
Practice Address - Country:US
Practice Address - Phone:914-237-1941
Practice Address - Fax:914-237-1950
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY181-559207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF20802Medicare UPIN