Provider Demographics
NPI:1770675902
Name:KESSLER, LAWRENCE JAY (DO)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JAY
Last Name:KESSLER
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:365 BROADWAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2716
Mailing Address - Country:US
Mailing Address - Phone:631-841-4102
Mailing Address - Fax:631-841-4104
Practice Address - Street 1:365 BROADWAY
Practice Address - Street 2:SUITE 1
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2716
Practice Address - Country:US
Practice Address - Phone:631-841-4102
Practice Address - Fax:631-841-4104
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-08-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY188733207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG07044Medicare UPIN
NY234002Medicare ID - Type Unspecified