Provider Demographics
NPI:1518904432
Name:LAWRENCE I. LIVINGSTON, M.D., P.A.
Entity Type:Organization
Organization Name:LAWRENCE I. LIVINGSTON, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-573-1202
Mailing Address - Street 1:21 PHILIPS PKWY
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1810
Mailing Address - Country:US
Mailing Address - Phone:201-573-1202
Mailing Address - Fax:201-573-8486
Practice Address - Street 1:21 PHILIPS PKWY
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1810
Practice Address - Country:US
Practice Address - Phone:201-573-1202
Practice Address - Fax:201-573-8486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03702700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD70550Medicare UPIN
NJLI416868Medicare ID - Type Unspecified