=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144596735
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAWRENCE B HURWITZ M.D.P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2012
-----------------------------------------------------
Last Update Date | 03/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5100 W TAFT RD STE 3J
-----------------------------------------------------
City | LIVERPOOL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13088-3809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-452-2250
-----------------------------------------------------
Fax | 315-452-2252
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5100 W TAFT RD STE 3J
-----------------------------------------------------
City | LIVERPOOL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13088-3809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-452-2250
-----------------------------------------------------
Fax | 315-452-2252
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LAWRENCE B HURWITZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 315-452-2250
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 096769
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------