Healthcare Provider Details

I. General information

NPI: 1992865117
Provider Name (Legal Business Name): PETER LENCHUR MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 E 3RD AVE
ROSELLE NJ
07203-1698
US

IV. Provider business mailing address

776 E 3RD AVE
ROSELLE NJ
07203-1698
US

V. Phone/Fax

Practice location:
  • Phone: 908-241-5545
  • Fax: 908-241-5548
Mailing address:
  • Phone: 908-241-5545
  • Fax: 908-241-5548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA061328
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number25MA061328
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number25MA061328
License Number StateNJ

VIII. Authorized Official

Name: DR. PETER LENCHUR
Title or Position: OWNER
Credential: MD PHD
Phone: 908-241-5545