Provider Demographics
NPI:1538661855
Name:LAWRENCE, RODNEY CRAIG SR (PAC)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:CRAIG
Last Name:LAWRENCE
Suffix:SR
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:510 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-1208
Mailing Address - Country:US
Mailing Address - Phone:516-399-2225
Mailing Address - Fax:516-399-2227
Practice Address - Street 1:510 OCEAN AVE STE 1
Practice Address - Street 2:
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-1208
Practice Address - Country:US
Practice Address - Phone:516-426-5721
Practice Address - Fax:516-399-2227
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000235-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000235-1OtherNYS LICENSE