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General NPI Number Information
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NPI Number | 1851569321
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Entity Type | Individual
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Provider Name | LAWRENCE BRUCE PALEVSKY MD
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Gender | Male
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Dates
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Enumeration Date | 02/18/2008
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Last Update Date | 02/18/2008
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Provider Practice Location Address
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Address Line | 220 FORT SALONGA RD SUITE 101
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City | NORTHPORT
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State | NY
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Zip | 11768-3900
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Country | US
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Telephone | 631-262-8505
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Fax |
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Provider Business Mailing Address
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Address Line | 220 FORT SALONGA RD SUITE 101
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City | NORTHPORT
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State | NY
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Zip | 11768-3900
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Country | US
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Telephone | 631-262-8505
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 175330
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2080P0008X
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Taxonomy Name | Pediatric Neurodevelopmental Disabilities Physician
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License Number | 175330
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License Number State | NY
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