MEDICARE: DR. LAWRENCE GORDON VANHORN JR. MD

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	207V00000X	Obstetrics & Gynecology Physician	MA67736	NJ

General Provider Information

NPI Number	:	1780631036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE GORDON VANHORN JR. MD

Provider Business Mailing Address
First Line	:	3350 HWY 138
Second Line	:	BUILDING 1, SUITE 115
City	:	WALL TOWNSHIP
State	:	NJ
Zip	:	07719-9693
Country	:	US
Telephone Number	:	732-280-8088
Fax Number	:	732-280-8801

Provider Business Practice Location Address
First Line	:	3350 HWY 138
Second Line	:	BUILDING 1, SUITE 115
City	:	WALL TOWNSHIP
State	:	NJ
Zip	:	07719-9693
Country	:	US
Telephone Number	:	732-280-8088
Fax Number	:	732-280-8801

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	07/08/2007

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