MEDICARE: LAKEWOOD MEDICAL ASSOCIATES

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	261QP2300X	Primary Care Clinic/Center	25MA04600800	NJ

General Provider Information

NPI Number	:	1851770606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEWOOD MEDICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	2290 W COUNTY LINE RD
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-2267
Country	:	US
Telephone Number	:	732-645-9988
Fax Number	:

Provider Business Practice Location Address
First Line	:	2290 W COUNTY LINE RD
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-2267
Country	:	US
Telephone Number	:	732-645-9988
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LAWRENCE SHONER
Credential	:	M.D.
Telephone Number	:	732-320-7597

Provider Enumeration Date	:	05/27/2015
Last Update Date	:	09/30/2015

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Directions to “LAKEWOOD MEDICAL ASSOCIATES ” Practice Location

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