Healthcare Provider Details

I. General information

NPI: 1700691417
Provider Name (Legal Business Name): LMBC MEDICAL SERVICES NEW JERSEY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PRINCETON SOUTH CORPORATE CTR STE 160
EWING NJ
08628-3435
US

IV. Provider business mailing address

382 NE 191ST ST PMB 688082
MIAMI FL
33179-3899
US

V. Phone/Fax

Practice location:
  • Phone: 877-742-2738
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: AVERY J KNAPP JR.
Title or Position: CEO
Credential: M.D.
Phone: 415-903-2000