Provider Demographics
NPI:1538112461
Name:OTTAVIANO, LAWRENCE J (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:J
Last Name:OTTAVIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:60 GRAMERCY PARK N
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5423
Mailing Address - Country:US
Mailing Address - Phone:212-254-1220
Mailing Address - Fax:212-254-1387
Practice Address - Street 1:60 GRAMERCY PARK N
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5423
Practice Address - Country:US
Practice Address - Phone:212-254-1220
Practice Address - Fax:212-254-1387
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2014-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY170703207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01152450Medicaid
NY06F871Medicare PIN
NY01152450Medicaid