Provider Demographics
NPI:1053393868
Name:TESSER, LAWRENCE MARK (DPM)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:MARK
Last Name:TESSER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
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:516-377-7705
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:516-377-7705
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005175213E00000X
FL0002526213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01531604Medicaid
NY01531604Medicaid