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General NPI Number Information
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NPI Number | 1386895423
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Entity Type | Organization
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Legal Business Name | LAWRENCE O. EGBUCHULAM, M.D., P.C.
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 10/07/2008
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Provider Practice Location Address
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Address Line | 84 SANFORD ST
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City | EAST ORANGE
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State | NJ
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Zip | 07018-1927
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Country | US
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Telephone | 973-674-6318
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Fax | 973-674-8953
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Provider Business Mailing Address
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Address Line | 84 SANFORD ST
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City | EAST ORANGE
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State | NJ
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Zip | 07018-1927
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Country | US
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Telephone | 973-674-6318
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Fax | 973-674-8953
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Authorized Official
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Title or Position | DIRECTOR
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Name | LAWRENCE EGBUCHULAM
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Credential | M.D.
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Telephone | 973-674-6318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 46686
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License Number State | NJ
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