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General NPI Number Information
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NPI Number | 1174677264
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Entity Type | Organization
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Legal Business Name | CORPORATE CARE
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 500 RIVER AVE
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City | LAKEWOOD
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State | NJ
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Zip | 08701-4721
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Country | US
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Telephone | 732-363-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 415 BIRCH BARK DR
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City | BRICK
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State | NJ
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Zip | 08723-4903
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Country | US
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Telephone | 732-477-3334
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Fax | 732-477-3334
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Authorized Official
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Title or Position | V.P. OF MEDICAL AFFAIRS
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Name | DR. ANTHONY LOMBARDINO
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Credential | M.D.
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Telephone | 732-363-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 26NN08747500
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License Number State | NJ
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