Provider Demographics
NPI:1013094523
Name:LAWRENCE R ROSENZWEIG DDS PC
Entity Type:Organization
Organization Name:LAWRENCE R ROSENZWEIG DDS PC
Other - Org Name:PROFESSIONAL CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ROSENZWEIG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-679-5959
Mailing Address - Street 1:3305 JERUSALEM AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793
Mailing Address - Country:US
Mailing Address - Phone:516-679-5959
Mailing Address - Fax:
Practice Address - Street 1:3305 JERUSALEM AVENUE
Practice Address - Street 2:SUITE 102
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793
Practice Address - Country:US
Practice Address - Phone:516-679-5959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037844122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty