MEDICARE: EMILY LAWRENCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1124432893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY LAWRENCE

Provider Business Mailing Address
First Line	:	28 MARINE AVE
Second Line	:	APARTMENT 4C
City	:	BROOKLYN
State	:	NY
Zip	:	11209-6709
Country	:	US
Telephone Number	:	412-290-3077
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 MARINE AVE
Second Line	:	APARTMENT 4C
City	:	BROOKLYN
State	:	NY
Zip	:	11209-6709
Country	:	US
Telephone Number	:	412-290-3077
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2014
Last Update Date	:	06/20/2014

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Directions to “ EMILY LAWRENCE ” Practice Location

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