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General NPI Number Information
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NPI Number | 1053147785
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Entity Type | Individual
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Provider Name | MADISON LACKEN
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Gender | Female
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Dates
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Enumeration Date | 09/10/2024
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 225 ROUTE 23 SUITE 1C
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City | HAMBURG
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State | NJ
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Zip | 07419
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Country | US
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Telephone | 973-209-1550
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Fax | 973-209-4832
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Provider Business Mailing Address
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Address Line | 532 LAFAYETTE RD STE 300
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City | SPARTA
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State | NJ
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Zip | 07871-4411
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Country | US
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Telephone | 973-795-4554
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Fax | 973-940-0399
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ15125800
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License Number State | NJ
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