Provider Demographics
NPI:1336199876
Name:JACOWITZ, LAWRENCE (DPM)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:JACOWITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 MAIN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1623
Mailing Address - Country:US
Mailing Address - Phone:845-255-3046
Mailing Address - Fax:845-255-0236
Practice Address - Street 1:1 FAMILY PRACTICE DR
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-6449
Practice Address - Country:US
Practice Address - Phone:845-338-6400
Practice Address - Fax:845-339-7288
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002499213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00414902Medicaid
NYT50791Medicare UPIN
NY00414902Medicaid