Provider Demographics
NPI:1669440038
Name:ENISMAN, LAWRENCE JACOB (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JACOB
Last Name:ENISMAN
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 1:16313 BRAEBURN RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-9528
Mailing Address - Country:US
Mailing Address - Phone:845-489-8242
Mailing Address - Fax:
Practice Address - Street 1:16313 BRAEBURN RIDGE TRL
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-9528
Practice Address - Country:US
Practice Address - Phone:845-489-8242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143464-1208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00841676Medicaid
NY18D82EY221Medicare PIN
NYC06394Medicare UPIN