Provider Demographics
NPI:1285821942
Name:LAWRENCE TESSER DPM PLLC
Entity type:Organization
Organization Name:LAWRENCE TESSER DPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:TESSER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-377-7701
Mailing Address - Street 1:1800 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4530
Mailing Address - Country:US
Mailing Address - Phone:516-377-7701
Mailing Address - Fax:
Practice Address - Street 1:1800 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4530
Practice Address - Country:US
Practice Address - Phone:516-377-7701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005175213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5310800001Medicare NSC
NYPYW171Medicare PIN