Provider Demographics
NPI:1710049077
Name:NISIVOCCIA, LAWRENCE WILLIAM III
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:WILLIAM
Last Name:NISIVOCCIA
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 LYN GALE CT
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-4111
Mailing Address - Country:US
Mailing Address - Phone:908-835-8656
Mailing Address - Fax:
Practice Address - Street 1:14 LYN GALE CT
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-4111
Practice Address - Country:US
Practice Address - Phone:908-835-8656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00727500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist