Healthcare Provider Details

I. General information

NPI: 1700847332
Provider Name (Legal Business Name): LAWRENCE A FERRARO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 WEST END AVENUE
SOMERVILLE NJ
08876
US

IV. Provider business mailing address

80 WEST END AVENUE
SOMERVILLE NJ
08876
US

V. Phone/Fax

Practice location:
  • Phone: 908-722-7400
  • Fax: 908-704-0552
Mailing address:
  • Phone: 908-722-7400
  • Fax: 908-704-0552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMB03185600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: