Provider Demographics
NPI:1083657506
Name:LAWLER, GREGORY J (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
Last Name:LAWLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6233 J.F. KENNEDY BLVD.
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047
Mailing Address - Country:US
Mailing Address - Phone:201-758-7550
Mailing Address - Fax:201-758-7549
Practice Address - Street 1:6233 JF KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-3451
Practice Address - Country:US
Practice Address - Phone:201-758-7550
Practice Address - Fax:201-758-7549
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB06538700207LP2900X
NJ25MB06538700207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG45919Medicare UPIN