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General NPI Number Information
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NPI Number | 1700087020
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Entity Type | Organization
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Legal Business Name | LAWRENCE J MENDITTO DPM PC
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 07/15/2011
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Provider Practice Location Address
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Address Line | 3200 SUNSET AVE
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City | OCEAN
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State | NJ
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Zip | 07712-4567
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Country | US
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Telephone | 732-531-4545
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Fax | 732-869-1246
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Provider Business Mailing Address
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Address Line | 3200 SUNSET AVE
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City | OCEAN
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State | NJ
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Zip | 07712-4567
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Country | US
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Telephone | 732-531-4545
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Fax | 732-869-1246
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Authorized Official
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Title or Position | PODIATRY
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Name | LAWRENCE MENDITTO
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Credential | D.P.M.
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Telephone | 732-531-4545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | MD02106
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License Number State | NJ
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