Healthcare Provider Details

I. General information

NPI: 1215937891
Provider Name (Legal Business Name): LAWRENCE FABRIZIO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 JAMES ST SUITE 130
FLORHAM PARK NJ
07932-1405
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 973-736-9557
  • Fax: 973-736-9757
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MB05373200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number25MB05373200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: