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General NPI Number Information
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NPI Number | 1508829318
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Entity Type | Individual
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Provider Name | IBIYONU OMOWUNMI LAWRENCE MD
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Gender | Female
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Dates
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Enumeration Date | 04/11/2006
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Last Update Date | 07/23/2021
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Provider Practice Location Address
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Address Line | 125 PATERSON ST
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-1962
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Country | US
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Telephone | 732-235-6968
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 829642
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City | PHILADELPHIA
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State | PA
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Zip | 19182-9642
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Country | US
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Telephone | 866-470-6626
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Fax | 413-599-0470
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 25MA0835900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD439522
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 25MA08359900
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA08359900
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License Number State | NJ
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