Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 0002526 | FL |
N | 222Z00000X | Podiatrist | 0002526 | FL |
Y | 213E00000X | Podiatrist | 005175 | NY |
Y | 222Z00000X | Podiatrist | 005175 | NY |
NPI | 1053393868 |
---|---|
Provider Name | Dr. Lawrence Mark Tesser |
First Address | Merrick, NY 11566-4530 |
Second Address | Merrick, NY 11566-4530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 22/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01531604 | (05) | NY |
U52741 | (02) |