Provider Demographics
NPI:1740403070
Name:HERBERT, LAWRENCE GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:GEORGE
Last Name:HERBERT
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 1:409 E 14TH ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-2700
Mailing Address - Country:US
Mailing Address - Phone:212-228-5010
Mailing Address - Fax:212-598-9699
Practice Address - Street 1:409 E 14TH ST
Practice Address - Street 2:SUITE F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-2700
Practice Address - Country:US
Practice Address - Phone:212-228-5010
Practice Address - Fax:212-598-9699
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179763-1208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01268973Medicaid
NY0100187OtherGHI PROVIDER ID
NY179763-8SOtherWORKMERS COMPENSATION
NY0100187OtherGHI PROVIDER ID
NYLH081F0710Medicare PIN
NYE94675Medicare UPIN