Provider Demographics
NPI:1952511297
Name:GULOTTA, LAWRENCE V (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:V
Last Name:GULOTTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:954 LEXINGTON AVE
Mailing Address - Street 2:166B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5055
Mailing Address - Country:US
Mailing Address - Phone:888-877-3850
Mailing Address - Fax:631-329-6951
Practice Address - Street 1:535 E 70TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4823
Practice Address - Country:US
Practice Address - Phone:646-797-8735
Practice Address - Fax:646-797-8726
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY233982207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03241210Medicaid
NY03241210Medicaid