| Lawrence Grill Mdpa | |
|
1166 River Ave Lakewood NJ 08701-5600 | |
| (732) 367-8272 | |
| Not Available |
| Full Name | Lawrence Grill Mdpa |
|---|---|
| Speciality | Internal Medicine |
| Location | 1166 River Ave, Lakewood, New Jersey |
| Authorized Official Name and Position | Kelly A Dennis (OFFICE MANAGER) |
| Authorized Official Contact | 7323678272 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lawrence Grill Mdpa 1166 River Ave Lakewood NJ 08701-5600 Ph: (732) 367-8272 | Lawrence Grill Mdpa 1166 River Ave Lakewood NJ 08701-5600 Ph: (732) 367-8272 |
| NPI Number | 1275561326 |
|---|---|
| Provider Enumeration Date | 06/29/2006 |
| Last Update Date | 06/12/2012 |
| Medicare PECOS PAC ID | 0749444966 |
|---|---|
| Medicare Enrollment ID | O20120619000313 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275561326 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Lawrence Grill |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063443844 PECOS PAC ID: 8022041862 Enrollment ID: I20050913000840 |
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