Healthcare Provider Details

I. General information

NPI: 1083748297
Provider Name (Legal Business Name): LAKEWOOD RESOURCE AND REFERRAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1771 MADISON AVE
LAKEWOOD NJ
08701-1251
US

IV. Provider business mailing address

1771 MADISON AVE
LAKEWOOD NJ
08701-1251
US

V. Phone/Fax

Practice location:
  • Phone: 732-364-2144
  • Fax: 732-364-3559
Mailing address:
  • Phone: 732-364-2144
  • Fax: 732-364-3559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number24191
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number24191
License Number StateNJ

VIII. Authorized Official

Name: MR. DAVID FRIEDMAN
Title or Position: C.E.O.
Credential:
Phone: 732-364-2144