Provider Demographics
NPI:1649267642
Name:PRICE, LARRY B (DPM)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:B
Last Name:PRICE
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 1:322 KINDERKAMACK RD
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-1635
Mailing Address - Country:US
Mailing Address - Phone:201-666-5115
Mailing Address - Fax:201-666-3703
Practice Address - Street 1:322 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-1635
Practice Address - Country:US
Practice Address - Phone:201-666-5115
Practice Address - Fax:201-666-3703
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MD00100300213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ103795CBWMedicare PIN