Healthcare Provider Details

I. General information

NPI: 1982718086
Provider Name (Legal Business Name): LAWRENCE B HURWITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7535 NORTHFIELD LN
MANLIUS NY
13104-2312
US

IV. Provider business mailing address

7535 NORTHFIELD LN
MANLIUS NY
13104-2312
US

V. Phone/Fax

Practice location:
  • Phone: 315-452-2250
  • Fax: 315-452-2252
Mailing address:
  • Phone: 315-452-2250
  • Fax: 315-452-2252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number096769
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number096769
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: