Healthcare Provider Details

I. General information

NPI: 1073843793
Provider Name (Legal Business Name): LAWRENCE LITTLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2009
Last Update Date: 12/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 TECHNOLOGY DR
EAST SETAUKET NY
11733-4000
US

IV. Provider business mailing address

1524 AUGUST RD
NORTH BABYLON NY
11703-1936
US

V. Phone/Fax

Practice location:
  • Phone: 631-689-6606
  • Fax: 631-941-3525
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: