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General NPI Number Information
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NPI Number | 1457585556
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Entity Type | Organization
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Legal Business Name | MOUNTAIN LAKES MEDICAL CENTER, LLC
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Dates
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Enumeration Date | 05/05/2009
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Last Update Date | 12/11/2013
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Provider Practice Location Address
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Address Line | 100 ROUTE 46 E BUILDING B, SUITE 204
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City | MOUNTAIN LAKES
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State | NJ
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Zip | 07046-1745
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Country | US
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Telephone | 973-917-3200
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Fax | 973-917-3201
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Provider Business Mailing Address
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Address Line | 100 ROUTE 46 E BUILDING B, SUITE 204
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City | MOUNTAIN LAKES
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State | NJ
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Zip | 07046-1745
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Country | US
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Telephone | 973-917-3200
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Fax | 973-917-3201
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD JOSEPH SCHWEITZER
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Credential | MD
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Telephone | 973-917-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 25MA07139700
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License Number State | NJ
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