Healthcare Provider Details

I. General information

NPI: 1619944923
Provider Name (Legal Business Name): LAWRENCE GEORGE ADELSOHN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2006
Last Update Date: 08/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 PROSPECT AVE SUITE 11
HACKENSACK NJ
07601-2255
US

IV. Provider business mailing address

140 PROSPECT AVE SUITE 11
HACKENSACK NJ
07601-2255
US

V. Phone/Fax

Practice location:
  • Phone: 201-342-4220
  • Fax: 201-342-4219
Mailing address:
  • Phone: 201-342-4220
  • Fax: 201-342-4219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMA02820700
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierBP427
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerOXFORD ID NONPAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: