Provider Demographics
NPI:1396792776
Name:KLUGER, LAWRENCE S (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:S
Last Name:KLUGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 ELLSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-7137
Mailing Address - Country:US
Mailing Address - Phone:732-563-1155
Mailing Address - Fax:732-563-1156
Practice Address - Street 1:35 ELLSWORTH DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-7137
Practice Address - Country:US
Practice Address - Phone:732-563-1155
Practice Address - Fax:732-563-1156
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA39126207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0990001Medicaid
NJ0990001Medicaid
NJ0990001Medicaid