Healthcare Provider Details

I. General information

NPI: 1144307166
Provider Name (Legal Business Name): LAFAYETTE MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 NEW YORK AVE
NEWARK NJ
07105-3125
US

IV. Provider business mailing address

390 NEW YORK AVE
NEWARK NJ
07105-3125
US

V. Phone/Fax

Practice location:
  • Phone: 973-344-3518
  • Fax: 973-344-1167
Mailing address:
  • Phone: 973-344-3518
  • Fax: 973-344-1167

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 Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: RENEE JULIE CABALEIRO
Title or Position: DOCTOR
Credential: MD
Phone: 973-344-3518