Healthcare Provider Details

I. General information

NPI: 1306322839
Provider Name (Legal Business Name): LC MEDICAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 CHESTNUT ST
NORWOOD NJ
07648-0001
US

IV. Provider business mailing address

335 CHESTNUT ST
NORWOOD NJ
07648-0001
US

V. Phone/Fax

Practice location:
  • Phone: 201-899-3560
  • Fax: 201-899-3561
Mailing address:
  • Phone: 201-899-3560
  • Fax: 201-899-3561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number25MA08886400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number25MA08886400
License Number StateNJ

VIII. Authorized Official

Name: LISA ANN CORRENTE
Title or Position: OWNER
Credential: MD
Phone: 201-899-3560