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General NPI Number Information
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NPI Number | 1881868263
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Entity Type | Organization
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Legal Business Name | EASTERN THORACIC SURGICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 04/17/2008
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Last Update Date | 07/24/2009
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Provider Practice Location Address
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Address Line | 65 MECHANIC ST SUITE 102
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City | RED BANK
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State | NJ
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Zip | 07701-1869
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Country | US
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Telephone | 732-741-9980
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Fax | 732-741-9982
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Provider Business Mailing Address
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Address Line | 65 MECHANIC ST SUITE 102
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City | RED BANK
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State | NJ
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Zip | 07701-1869
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Country | US
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Telephone | 732-741-9980
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Fax | 732-741-9982
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Authorized Official
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Title or Position | PHYSICIAN
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Name | LOURENS J WILLEKES II
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Credential | M.D.
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Telephone | 732-741-9980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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