Healthcare Provider Details

I. General information

NPI: 1134467319
Provider Name (Legal Business Name): JOSEPH H LAX
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W KENNEDY BLVD
LAKEWOOD NJ
08701-1254
US

IV. Provider business mailing address

18 KEW GARDENS DR
LAKEWOOD NJ
08701-7101
US

V. Phone/Fax

Practice location:
  • Phone: 732-725-2826
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL05753100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: