Basic Information
| Provider Information | |||||||||
| NPI: | 1023092368 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAWRENCE C. ANTONUCCI MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 ROUTE 24 | ||||||||
| Address2: | SU E | ||||||||
| City: | CHESTER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079302920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9088791500 | ||||||||
| FaxNumber: | 9088791515 | ||||||||
| Practice Location | |||||||||
| Address1: | 415 ROUTE 24 | ||||||||
| Address2: | SU E | ||||||||
| City: | CHESTER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079302920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9088791500 | ||||||||
| FaxNumber: | 9088791515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 02/11/2014 | ||||||||
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| AuthorizedOfficialLastName: | ANTONUCCI | ||||||||
| AuthorizedOfficialFirstName: | LAWRENCE | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9088791500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 25MA04759200 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 2198207 | 01 | GHI | OTHER | 2K5143 | 01 | HEALTH NET | OTHER | 303755 | 01 | US STANLEY | OTHER | IS055 | 01 | OXFORD | OTHER | 109881 | 01 | CHN | OTHER | 536P31 | 01 | WELL CHOICE CHESTER | OTHER | 536P32 | 01 | MORRISTOWN | OTHER |