Healthcare Provider Details

I. General information

NPI: 1740282607
Provider Name (Legal Business Name): JEROME LAMENDOLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date: 03/22/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

15810 DETROIT AVE
LAKEWOOD OH
44107-3711
US

IV. Provider business mailing address

30575 EUCLID AVE
WICKLIFFE OH
44092-1037
US

V. Phone/Fax

Practice location:
  • Phone: 216-529-1800
  • Fax: 216-529-3201
Mailing address:
  • Phone: 440-516-3776
  • Fax: 440-516-3783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36-00-2157-L
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: