Provider Demographics
NPI:1083684914
Name:ANTONUCCI, LAWRENCE CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:CHARLES
Last Name:ANTONUCCI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 ROUTE 24
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930
Mailing Address - Country:US
Mailing Address - Phone:908-879-1500
Mailing Address - Fax:908-879-1515
Practice Address - Street 1:415 ROUTE 24
Practice Address - Street 2:SUITE E
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930
Practice Address - Country:US
Practice Address - Phone:908-879-1500
Practice Address - Fax:908-879-1515
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04759200207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
2K5143OtherHEALTHNET
4232346OtherNON HMO
62677528OtherMULTI PLAN
542139628OtherBC/BS
3430588OtherAETNA HMO
542139628OtherUNITED HEALTH CARE
68334OtherLOCAL 825
010000599500OtherAMERICHOICE
0844060OtherCIGNA
P00064234OtherRR MEDICARE
0211089000OtherAMERI HEALTH HMO PIN
109881OtherCHN
536P31OtherWELL CHOICE - CHESTER
16131OtherUHP
303755OtherUS STANLEY
IS055OtherOXFORD
2198207OtherGHI
536P32OtherWELL CHOICE - MORRISTOWN
68334OtherLOCAL 825
E22074Medicare UPIN