=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447832779
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAWRENCE CECCHI MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2021
-----------------------------------------------------
Last Update Date | 04/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6157 US ROUTE 20
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-425-7722
-----------------------------------------------------
Fax | 315-475-1705
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 475 IRVING AVE STE 420
-----------------------------------------------------
City | SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13210-1573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-425-7722
-----------------------------------------------------
Fax | 315-475-1705
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. LAWRENCE M CECCHI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 315-425-7722
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------