Provider Demographics
NPI:1972579902
Name:CONLEY, LAWRENCE (RPA)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:
Last Name:CONLEY
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 W TAFT RD
Mailing Address - Street 2:SUITE 2G
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3807
Mailing Address - Country:US
Mailing Address - Phone:315-312-0089
Mailing Address - Fax:315-234-8981
Practice Address - Street 1:5100 W TAFT RD
Practice Address - Street 2:SUITE #2G
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3807
Practice Address - Country:US
Practice Address - Phone:315-234-8977
Practice Address - Fax:315-234-8981
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002256-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS98980Medicare UPIN
NYPA0493Medicare ID - Type Unspecified