Healthcare Provider Details

I. General information

NPI: 1144406414
Provider Name (Legal Business Name): LIFECARE PHYSICIANS, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 WHITEHORSE MERCERVILLE RD. BUILDING D SUITE 203 LIFECARE PHYSICIANS OF HAMITTON
HAMITTON NJ
08619-3882
US

IV. Provider business mailing address

500 GROVE STREET CREDENTIALING SUITE 100
HADDON HEIGHTS NJ
08035-1761
US

V. Phone/Fax

Practice location:
  • Phone: 609-581-6060
  • Fax: 609-581-9561
Mailing address:
  • Phone: 856-323-1208
  • Fax: 856-796-9397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA39516
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMA39516
License Number StateNJ

VIII. Authorized Official

Name: CARMEN J ROMANO
Title or Position: MEDICAL DOCTOR
Credential: M.D
Phone: 609-599-5095