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General NPI Number Information
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NPI Number | 1003795139
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Entity Type | Organization
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Legal Business Name | APEX MEDICAL OVERSIGHT, PLLC
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Dates
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Enumeration Date | 09/02/2025
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 2418 E YORK ST
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City | PHILADELPHIA
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State | PA
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Zip | 19125-3006
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Country | US
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Telephone | 302-500-4412
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Fax | 302-444-8312
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Provider Business Mailing Address
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Address Line | 1614 N BODINE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19122-3034
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Country | US
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Telephone | 302-500-4412
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Fax | 302-444-8312
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Authorized Official
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Title or Position | MEMBER
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Name | DR. MICHAEL LACQUA
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Credential | MD
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Telephone | 917-301-1699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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