Provider Demographics
NPI:1235176561
Name:LARSEN, LIND S (MD)
Entity Type:Individual
Prefix:MR
First Name:LIND
Middle Name:S
Last Name:LARSEN
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 1:651 W MOUNT PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1600
Mailing Address - Country:US
Mailing Address - Phone:973-251-1177
Mailing Address - Fax:973-251-1165
Practice Address - Street 1:727 N BEERS ST
Practice Address - Street 2:BAYSHORE COMMUNITY CENTER
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1514
Practice Address - Country:US
Practice Address - Phone:732-739-5900
Practice Address - Fax:973-251-1109
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04254300207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ110180583OtherRAILROAD MEDICARE
NJ110180583OtherRAILROAD MEDICARE
NJ632158Medicare ID - Type Unspecified