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NPI Code Detail

MEDICARE: LAKEWOOD WELLNESS CENTER, LLC

MEDICARE: LAKEWOOD WELLNESS CENTER, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor38MC00649200NJ

General Provider Information

NPI Number : 1114097367
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKEWOOD WELLNESS CENTER, LLC
Provider Business Mailing Address
First Line : 1700 MADISON AVE
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-1253
Country : US
Telephone Number : 732-363-7900
Fax Number :
Provider Business Practice Location Address
First Line : 1700 MADISON AVE
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-1253
Country : US
Telephone Number : 732-363-7900
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. STUART JEFFREY PODOB
Credential : D.C.
Telephone Number : 732-363-7900
Provider Enumeration Date : 11/08/2006
Last Update Date : 10/17/2008

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Directions to “LAKEWOOD WELLNESS CENTER, LLC ” Practice Location

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