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General NPI Number Information
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NPI Number | 1821097908
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Entity Type | Individual
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Provider Name | LAWRENCE BRIAN LAVEMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 96 MILLBURN AVE SUITE 203
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City | MILLBURN
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State | NJ
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Zip | 07041-1944
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Country | US
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Telephone | 973-994-0490
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Fax | 973-762-3554
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Provider Business Mailing Address
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Address Line | 71 E SHERBROOKE PKWY
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City | LIVINGSTON
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State | NJ
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Zip | 07039-3135
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Country | US
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Telephone |
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Fax |
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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 | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number | 25MA05847300
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License Number State | NJ
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