Provider Demographics
NPI:1861541146
Name:MEYERS, LAWRENCE S (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:S
Last Name:MEYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LARRY
Other - Middle Name:S
Other - Last Name:NIJAKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:150 FLORAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-1557
Mailing Address - Country:US
Mailing Address - Phone:908-273-4300
Mailing Address - Fax:908-790-6576
Practice Address - Street 1:1 DIAMOND HILL RD
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-2104
Practice Address - Country:US
Practice Address - Phone:908-273-4300
Practice Address - Fax:908-790-6576
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04357100207N00000X, 207NS0135X
NJMA04357100207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ520245RJEMedicare ID - Type UnspecifiedGROUP ASSIGNMENT#
NJ520245Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NO.
NJD06770Medicare UPIN