Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 25MA03702700 | NJ |
NPI | 1003853102 |
---|---|
Provider Name | Lawrence I Livingston |
First Address | Montvale, NJ 07645 |
Second Address | Montvale, NJ 07645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D70550 | (02) |