Healthcare Provider Details

I. General information

NPI: 1730268962
Provider Name (Legal Business Name): LAWRENCE NOBLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S ROOM 803
BRONX NY
10461-1138
US

IV. Provider business mailing address

1560 PELHAM PKWY S APT 4E
BRONX NY
10461-1114
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-6990
  • Fax: 718-918-7510
Mailing address:
  • Phone: 914-441-2316
  • Fax: 718-918-7510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number152732
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: