Healthcare Provider Details

I. General information

NPI: 1518904432
Provider Name (Legal Business Name): LAWRENCE I. LIVINGSTON, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 PHILIPS PKWY
MONTVALE NJ
07645-1810
US

IV. Provider business mailing address

21 PHILIPS PKWY
MONTVALE NJ
07645-1810
US

V. Phone/Fax

Practice location:
  • Phone: 201-573-1202
  • Fax: 201-573-8486
Mailing address:
  • Phone: 201-573-1202
  • Fax: 201-573-8486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA03702700
License Number StateNJ

VIII. Authorized Official

Name: DR. LAWRENCE IRA LIVINGSTON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 201-573-1202