Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | DI16442 | NJ |
NPI | 1235262064 |
---|---|
Provider Name | Dr. Lawrence Mark Gorzelnik |
First Address | Morristown, NJ 07961-0362 |
Second Address | Madison, NJ 07940-2631 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 15/08/2019 |