MEDICARE: DR. LAWRENCE BRIAN LAVEMAN 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	2080P0006X	Developmental - Behavioral Pediatrics Physician	25MA05847300	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	:	1821097908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE BRIAN LAVEMAN M.D.

Provider Business Mailing Address
First Line	:	71 E SHERBROOKE PKWY
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-3135
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	96 MILLBURN AVE
Second Line	:	SUITE 203
City	:	MILLBURN
State	:	NJ
Zip	:	07041-1944
Country	:	US
Telephone Number	:	973-994-0490
Fax Number	:	973-762-3554

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	07/08/2007

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