Provider Demographics
NPI:1295765691
Name:MENDELSBERG, LAWRENCE M (DC)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:M
Last Name:MENDELSBERG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 FOREST AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5410
Mailing Address - Country:US
Mailing Address - Phone:201-986-1881
Mailing Address - Fax:201-986-1871
Practice Address - Street 1:277 FOREST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5410
Practice Address - Country:US
Practice Address - Phone:201-986-1881
Practice Address - Fax:201-986-1871
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC02102111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T45169Medicare UPIN
NJ451050ABFMedicare ID - Type Unspecified