Provider Demographics
NPI:1952357121
Name:STABILE, LAWRENCE C (DPM)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:C
Last Name:STABILE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MILL ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-1886
Mailing Address - Country:US
Mailing Address - Phone:973-881-1115
Mailing Address - Fax:973-881-8686
Practice Address - Street 1:21 MILL ST
Practice Address - Street 2:SUITE 3
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-1886
Practice Address - Country:US
Practice Address - Phone:973-881-1115
Practice Address - Fax:973-881-8686
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00236400213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7006501Medicaid
NJU62497Medicare UPIN
NJ4387630001Medicare NSC
NJ886930Medicare PIN