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General NPI Number Information
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NPI Number | 1912236068
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE PRIMARY CARE SERVICES, LLC
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Dates
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Enumeration Date | 12/21/2009
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Last Update Date | 12/21/2009
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Provider Practice Location Address
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Address Line | 1173 BEACON AVE SUITE B
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City | MANAHAWKIN
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State | NJ
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Zip | 08050-2420
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Country | US
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Telephone | 609-597-5636
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Fax | 609-597-5631
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Provider Business Mailing Address
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Address Line | 282 LIGHTHOUSE DR
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City | MANAHAWKIN
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State | NJ
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Zip | 08050-2530
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Country | US
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Telephone | 609-597-5636
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Fax | 609-597-5631
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Authorized Official
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Title or Position | OWNER/PRACTITIONER
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Name | MS. JULIE D. LAMBERT
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Credential | NP
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Telephone | 609-597-5636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 26NJ00071700
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License Number State | NJ
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