| Doctor Name: | DR. LAWRENCE MADOFF |
| NPI Number: | 1518007566 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | A21016 |
| Business Practice Address: | 6411 Sepulveda Boulevard Suite 2-b Van Nuys, CA - 914111304 |
| Business Phone Number: | 8183410103 |
| Business Fax Number: | 8183410106 |
| Mailing Address: | 6411 Sepulveda Blvd Suite 2-b, VAN NUYS |
| State: | CA |
| Postal Code: | 914111304 |
| Phone Number: | 8183410103 |
| Fax Number: | 8183410106 |
| NPI Enumeration Date: | 02/07/2007 |
| NPI Last Update Date: | 03/25/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | A21016 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |