Provider Demographics
NPI:1710961826
Name:LAWRENCE, SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:LAWRENCE
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 1:216 CONGERS RD
Mailing Address - Street 2:SUITE #2E
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-6261
Mailing Address - Country:US
Mailing Address - Phone:845-639-9611
Mailing Address - Fax:845-634-3477
Practice Address - Street 1:216 CONGERS RD
Practice Address - Street 2:SUITE #2E
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-6261
Practice Address - Country:US
Practice Address - Phone:845-639-9611
Practice Address - Fax:845-634-3477
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1531942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00772692Medicaid
NY00772692Medicaid
NY00772692Medicaid
13D131Medicare ID - Type Unspecified