Individual
IBIYONU OMOWUNMI LAWRENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
125 PATERSON ST, NEW BRUNSWICK, NJ 08901-1962
(732) 235-6968
Mailing address
PO BOX 829642, PHILADELPHIA, PA 19182-9642
(866) 470-6626
(413) 599-0470
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
25MA0835900
NJ
207R00000X
Internal Medicine Physician
Primary
25MA08359900
NJ
207R00000X
Internal Medicine Physician
MD439522
PA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
25MA08359900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102517277
—
PA
Enumeration date
04/11/2006
Last updated
07/23/2021
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