Provider Demographics
NPI:1255321899
Name:SOBOCINSKI, LAWRENCE JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JOSEPH
Last Name:SOBOCINSKI
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 1:11011 72ND AVE
Mailing Address - Street 2:APT 1A
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4946
Mailing Address - Country:US
Mailing Address - Phone:718-544-6900
Mailing Address - Fax:718-544-6901
Practice Address - Street 1:11011 72ND AVE
Practice Address - Street 2:APT 1A
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4946
Practice Address - Country:US
Practice Address - Phone:718-544-6900
Practice Address - Fax:718-544-6901
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097686-1208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B88620Medicare UPIN
49775Medicare ID - Type Unspecified