Provider Demographics
NPI:1982618146
Name:HANAUER, LONNIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LONNIE
Middle Name:
Last Name:HANAUER
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 1:143 FOREST HILL RD
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3943
Mailing Address - Country:US
Mailing Address - Phone:973-736-3234
Mailing Address - Fax:
Practice Address - Street 1:116 MILLBURN AVE
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1943
Practice Address - Country:US
Practice Address - Phone:973-376-2545
Practice Address - Fax:973-467-4207
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 018785174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist