Provider Demographics
NPI:1487859443
Name:VARGAS, LAWRENCE PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:PETER
Last Name:VARGAS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-2751
Mailing Address - Country:US
Mailing Address - Phone:732-815-0250
Mailing Address - Fax:732-815-0231
Practice Address - Street 1:1155 LAKE AVE
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-2751
Practice Address - Country:US
Practice Address - Phone:732-815-0250
Practice Address - Fax:732-815-0231
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MCOO281300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJVA536537Medicare ID - Type Unspecified