Provider Demographics
NPI:1609898469
Name:ADLER, LAWRENCE A (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:A
Last Name:ADLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 KAPPOCK ST
Mailing Address - Street 2:APT.1107
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4612
Mailing Address - Country:US
Mailing Address - Phone:718-549-6841
Mailing Address - Fax:
Practice Address - Street 1:355 W 52ND ST
Practice Address - Street 2:7TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6239
Practice Address - Country:US
Practice Address - Phone:646-778-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230633207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02470Medicare UPIN
NY0528P1Medicare ID - Type Unspecified