Provider Demographics
NPI:1578631891
Name:OGNIBENE, LAWRENCE (DO)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:OGNIBENE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 BETHEL RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2172
Mailing Address - Country:US
Mailing Address - Phone:609-926-3330
Mailing Address - Fax:609-926-9033
Practice Address - Street 1:408 BETHEL RD
Practice Address - Street 2:SUITE E
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2172
Practice Address - Country:US
Practice Address - Phone:609-926-3330
Practice Address - Fax:609-926-9033
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB057777207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5763096OtherAETNA
NJ628364OtherAMERIHEALTH
NJ6712401Medicaid
NJ628364OtherAMERIHEALTH
NJ6712401Medicaid