Provider Demographics
NPI:1619057122
Name:HERNANDEZ, LAWRENCE
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 SOUTH AVE
Mailing Address - Street 2:SUITE #205 LAWRENCE HERNANDEZ
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023
Mailing Address - Country:US
Mailing Address - Phone:908-889-7900
Mailing Address - Fax:908-889-6003
Practice Address - Street 1:313 SOUTH AVE
Practice Address - Street 2:SUITE #205 PANTHER PT AND SPORTS MEDICINE
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023
Practice Address - Country:US
Practice Address - Phone:908-889-7900
Practice Address - Fax:908-889-6003
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA08639225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist