Provider Demographics
NPI:1619944923
Name:ADELSOHN, LAWRENCE GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:GEORGE
Last Name:ADELSOHN
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 1:140 PROSPECT AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2255
Mailing Address - Country:US
Mailing Address - Phone:201-342-4220
Mailing Address - Fax:201-342-4219
Practice Address - Street 1:140 PROSPECT AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2255
Practice Address - Country:US
Practice Address - Phone:201-342-4220
Practice Address - Fax:201-342-4219
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-06
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA02820700207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJBP427OtherOXFORD ID NONPAR
NJ145320Medicare ID - Type Unspecified
NJC61507Medicare UPIN