Provider Demographics
NPI:1891964953
Name:LODICO, LAWRENCE R III (CWS, ATS)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:R
Last Name:LODICO
Suffix:III
Gender:M
Credentials:CWS, ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 TILTON RD STE 3
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1858
Mailing Address - Country:US
Mailing Address - Phone:609-748-2434
Mailing Address - Fax:609-748-3015
Practice Address - Street 1:1601 TILTON RD STE 3
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1858
Practice Address - Country:US
Practice Address - Phone:609-748-2434
Practice Address - Fax:609-748-3015
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-22
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ233010478332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1356360325OtherNPI
NJ1186530001Medicare NSC