Provider Demographics
NPI:1255307989
Name:MILGRIM, LAURENCE M (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:M
Last Name:MILGRIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 419430
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-9430
Mailing Address - Country:US
Mailing Address - Phone:201-967-8221
Mailing Address - Fax:201-483-2242
Practice Address - Street 1:1 RUCKMAN RD
Practice Address - Street 2:
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-2100
Practice Address - Country:US
Practice Address - Phone:201-385-6161
Practice Address - Fax:201-385-1671
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08378800207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology