Provider Demographics
NPI:1427389758
Name:LAWRENCE R. SIROTA, DO, PC
Entity Type:Organization
Organization Name:LAWRENCE R. SIROTA, DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SIROTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-791-3150
Mailing Address - Street 1:936 WILLIS AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507
Mailing Address - Country:US
Mailing Address - Phone:516-791-3150
Mailing Address - Fax:516-791-3913
Practice Address - Street 1:936 WILLIS AVENUE
Practice Address - Street 2:
Practice Address - City:ALBERTSON
Practice Address - State:NY
Practice Address - Zip Code:11507
Practice Address - Country:US
Practice Address - Phone:516-791-3150
Practice Address - Fax:516-791-3913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203715208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6T9451Medicare UPIN