Provider Demographics
NPI:1437193331
Name:LAWRENCE, ERIC (PT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1937 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-6208
Mailing Address - Country:US
Mailing Address - Phone:631-462-9595
Mailing Address - Fax:631-462-9613
Practice Address - Street 1:1937 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-6208
Practice Address - Country:US
Practice Address - Phone:631-462-9595
Practice Address - Fax:631-462-9613
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011565225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ69361Medicare ID - Type Unspecified