MEDICARE: LAWRENCE D. BUDNICK M.D.

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	207R00000X	Internal Medicine Physician	25MA05250500	NJ
2	2083P0901X	Public Health & General Preventive Medicine Physician	25MA05250500	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801812136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE D. BUDNICK M.D.

Provider Business Mailing Address
First Line	:	30 BERGEN ST
Second Line	:	ADMC 12 1205
City	:	NEWARK
State	:	NJ
Zip	:	07107-3000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 BERGEN ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07107-3001
Country	:	US
Telephone Number	:	973-972-2900
Fax Number	:	973-972-2904

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	06/08/2009

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