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General NPI Number Information
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NPI Number | 1740282607
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Entity Type | Individual
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Provider Name | JEROME LAMENDOLA
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Gender | Male
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 01/24/2011
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Provider Practice Location Address
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Address Line | 15810 DETROIT AVE
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City | LAKEWOOD
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State | OH
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Zip | 44107-3711
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Country | US
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Telephone | 216-529-1800
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Fax | 216-529-3201
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Provider Business Mailing Address
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Address Line | 30575 EUCLID AVE
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City | WICKLIFFE
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State | OH
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Zip | 44092-1037
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Country | US
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Telephone | 440-516-3776
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Fax | 440-516-3783
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 36-00-2157-L
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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