Provider Demographics
NPI:1780690990
Name:BIRZON, LAWRENCE R (DC, PT)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:R
Last Name:BIRZON
Suffix:
Gender:M
Credentials:DC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3734 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1002
Mailing Address - Country:US
Mailing Address - Phone:716-874-1500
Mailing Address - Fax:716-874-6396
Practice Address - Street 1:3734 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1002
Practice Address - Country:US
Practice Address - Phone:716-874-1500
Practice Address - Fax:716-874-6396
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009221-1225100000X
NYX003059-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00020137801OtherUNIVERA
NY1030314OtherAETNA
NY8803885OtherINDEPENDENT HEALTH
NY000608461004OtherBC BS COMMUNITY BLUE
NY00978432Medicaid
NY801640OtherEMPIRE PLAN
NY00011191301OtherUNIVERA
NY00208461002OtherBC BS COMMUNITY BLUE
NY084614Medicare PIN
NY084612Medicare PIN