Provider Demographics
NPI:1316699614
Name:LAWRENCE, ELEANOR STORER (LAC, MSTOM)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:STORER
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:LAC, MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 W 17TH ST # 300
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-5503
Mailing Address - Country:US
Mailing Address - Phone:212-533-2255
Mailing Address - Fax:
Practice Address - Street 1:37 W 17TH ST # 300
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5503
Practice Address - Country:US
Practice Address - Phone:212-533-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007064171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist