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General NPI Number Information
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NPI Number | 1891241592
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Entity Type | Individual
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Provider Name | JEFFERY CONRAD LAWRENCE M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 573 EAST NEW YORK AVE. APT 1
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City | BROOKLYN
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State | NY
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Zip | 11225
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Country | US
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Telephone | 484-574-2206
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Fax |
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Provider Business Mailing Address
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Address Line | 1902 WOODBROOK DR
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City | WILMINGTON
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State | DE
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Zip | 19810-4342
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 302469
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License Number State | NY
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