Provider Demographics
NPI:1851569321
Name:PALEVSKY, LAWRENCE BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:BRUCE
Last Name:PALEVSKY
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 1:220 FORT SALONGA RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-3900
Mailing Address - Country:US
Mailing Address - Phone:631-262-8505
Mailing Address - Fax:
Practice Address - Street 1:220 FORT SALONGA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-3900
Practice Address - Country:US
Practice Address - Phone:631-262-8505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175330208000000X, 2080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities