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General NPI Number Information
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NPI Number | 1013089499
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Entity Type | Organization
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Legal Business Name | LAKEWOOD SURGICAL GROUP PA
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 07/16/2010
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Provider Practice Location Address
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Address Line | 9 HOSPITAL DRIVE SUITE C23
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City | TOMS RIVER
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State | NJ
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Zip | 08755-6425
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Country | US
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Telephone | 732-341-0470
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Fax | 732-341-0473
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Provider Business Mailing Address
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Address Line | 9 HOSPITAL DRIVE SUITE C23
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City | TOMS RIVER
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State | NJ
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Zip | 08755-6425
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Country | US
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Telephone | 732-341-0470
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Fax | 732-341-0473
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. WANDA M PRETTO
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Credential |
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Telephone | 732-341-0470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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