Provider Demographics
NPI:1790818672
Name:NEWMAN, LAWRENCE
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 LAKEHURST RD STE 202&204
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8063
Mailing Address - Country:US
Mailing Address - Phone:732-349-1201
Mailing Address - Fax:
Practice Address - Street 1:530 LAKEHURST RD STE 202&204
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8063
Practice Address - Country:US
Practice Address - Phone:732-349-1201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00654400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223624926OtherTAX ID
NJ055255QCRMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE ID