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General NPI Number Information
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NPI Number | 1235149782
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Entity Type | Organization
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Legal Business Name | LAWRENCE GASTROENTEROLOGY, PA
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 3100 PRINCETON PIKE BLDG 4, SUITE C
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648
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Country | US
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Telephone | 609-882-2185
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Fax | 609-882-0347
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Provider Business Mailing Address
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Address Line | PO BOX 914
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City | PENNINGTON
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State | NJ
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Zip | 08534-0914
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Country | US
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Telephone | 609-882-2185
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSEPH DEANTONIO
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Credential | M.D.
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Telephone | 609-882-2185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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