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General NPI Number Information
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NPI Number | 1023092368
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Entity Type | Organization
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Legal Business Name | LAWRENCE C. ANTONUCCI MD LLC
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Dates
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Enumeration Date | 11/30/2005
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Last Update Date | 02/11/2014
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Provider Practice Location Address
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Address Line | 415 ROUTE 24 SU E
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City | CHESTER
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State | NJ
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Zip | 07930-2920
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Country | US
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Telephone | 908-879-1500
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Fax | 908-879-1515
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Provider Business Mailing Address
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Address Line | 415 ROUTE 24 SU E
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City | CHESTER
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State | NJ
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Zip | 07930-2920
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Country | US
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Telephone | 908-879-1500
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Fax | 908-879-1515
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Authorized Official
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Title or Position | OWNER
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Name | DR. LAWRENCE C ANTONUCCI
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Credential | MD
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Telephone | 908-879-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 25MA04759200
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License Number State | NJ
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