Provider Demographics
NPI:1891044772
Name:LAWRENCE KORN, MD LLC
Entity Type:Organization
Organization Name:LAWRENCE KORN, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LICUL
Authorized Official - Suffix:
Authorized Official - Credentials:RMC
Authorized Official - Phone:516-482-4343
Mailing Address - Street 1:900 NORTHERN BLVD
Mailing Address - Street 2:SUITE 245
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5337
Mailing Address - Country:US
Mailing Address - Phone:516-482-4343
Mailing Address - Fax:516-482-0112
Practice Address - Street 1:900 NORTHERN BLVD
Practice Address - Street 2:SUITE 245
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5337
Practice Address - Country:US
Practice Address - Phone:516-482-4343
Practice Address - Fax:516-482-0112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187213207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty