Healthcare Provider Details

I. General information

NPI: 1457989881
Provider Name (Legal Business Name): JAMIE LANTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4257 ROUTE 9 N BLDG 6
FREEHOLD NJ
07728-8310
US

IV. Provider business mailing address

4257 ROUTE 9 N STE B
FREEHOLD NJ
07728-8310
US

V. Phone/Fax

Practice location:
  • Phone: 732-303-9660
  • Fax:
Mailing address:
  • Phone: 732-303-9660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA00103800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: