Basic Information
| Provider Information | |||||||||
| NPI: | 1083684914 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANTONUCCI | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | CHARLES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 ROUTE 24 | ||||||||
| Address2: | SUITE E | ||||||||
| City: | CHESTER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9088791500 | ||||||||
| FaxNumber: | 9088791515 | ||||||||
| Practice Location | |||||||||
| Address1: | 415 ROUTE 24 | ||||||||
| Address2: | SUITE E | ||||||||
| City: | CHESTER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9088791500 | ||||||||
| FaxNumber: | 9088791515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 09/09/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 25MA04759200 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 2K5143 | 01 | HEALTHNET | OTHER | 4232346 | 01 | NON HMO | OTHER | 62677528 | 01 | MULTI PLAN | OTHER | 542139628 | 01 | BC/BS | OTHER | 3430588 | 01 | AETNA HMO | OTHER | 542139628 | 01 | UNITED HEALTH CARE | OTHER | 68334 | 01 | LOCAL 825 | OTHER | 010000599500 | 01 | AMERICHOICE | OTHER | 0844060 | 01 | CIGNA | OTHER | P00064234 | 01 | RR MEDICARE | OTHER | 0211089000 | 01 | AMERI HEALTH HMO PIN | OTHER | 109881 | 01 | CHN | OTHER | 536P31 | 01 | WELL CHOICE - CHESTER | OTHER | 16131 | 01 | UHP | OTHER | 303755 | 01 | US STANLEY | OTHER | IS055 | 01 | OXFORD | OTHER | 2198207 | 01 | GHI | OTHER | 536P32 | 01 | WELL CHOICE - MORRISTOWN | OTHER |