MEDICARE: TANESHA D LAWRENCE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	236983	NY

General Provider Information

NPI Number	:	1548330749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANESHA D LAWRENCE MD

Provider Business Mailing Address
First Line	:	894 BEDFORD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-3913
Country	:	US
Telephone Number	:	718-222-5999
Fax Number	:	718-387-6429

Provider Business Practice Location Address
First Line	:	1704 NOBLE ST
Second Line	:
City	:	EAST MEADOW
State	:	NY
Zip	:	11554-5007
Country	:	US
Telephone Number	:	516-862-0200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	01/04/2023

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