MEDICARE: LADACIN NETWORK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency		NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053790519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LADACIN NETWORK

Provider Business Mailing Address
First Line	:	1703 KNEELEY BLVD
Second Line	:
City	:	OCEAN
State	:	NJ
Zip	:	07712-7622
Country	:	US
Telephone Number	:	732-493-5900
Fax Number	:	732-493-5980

Provider Business Practice Location Address
First Line	:	725 AIRPORT RD
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5968
Country	:	US
Telephone Number	:	732-534-9788
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	PATRICIA CARLESIMO
Credential	:
Telephone Number	:	732-493-5900

Provider Enumeration Date	:	05/29/2015
Last Update Date	:	05/29/2015

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1447688635 — MR. LAWRENCE GREENSTEIN
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Directions to “LADACIN NETWORK ” Practice Location

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