Provider Demographics
NPI:1619977709
Name:ROUTENBERG, LAWRENCE J (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:J
Last Name:ROUTENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1201 NOTT ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2589
Mailing Address - Country:US
Mailing Address - Phone:518-374-3123
Mailing Address - Fax:518-374-9711
Practice Address - Street 1:1201 NOTT ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2589
Practice Address - Country:US
Practice Address - Phone:518-374-3123
Practice Address - Fax:518-374-9711
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2011-01-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY138025-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAN1380252OtherWORKERS COMP
00A29OtherEMPIRE BLUE CROSS
000405089001OtherBLUE SHIELD NENY
138025-1OtherTRICARE NORTH REGION
000000084108OtherGHI HMO
000405089003OtherBLUE SHIELD NENY
NY00392883Medicaid
10001755OtherCDPHP
B80762OtherAMERICAN PROGRESSIVE TODA
LR000A2910OtherEMPIRE BLUE CROSS
LR000A2920OtherEMPIRE BLUE CROSS
040426006821OtherFIDELIS
05112OtherMVP
110160500OtherUS DEPT OF LABOR
33570QOtherFIDELIS MEDICARE
9701846OtherGHI
CAN1380252OtherNO FAULT
05112OtherMVP
138025-1OtherTRICARE NORTH REGION
050027698Medicare PIN