Basic Information
| Provider Information | |||||||||
| NPI: | 1053307157 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TOWNSHIP OF LAKEWOOD OCEAN COUNTY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1555 PINE ST | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087014904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7329018487 | ||||||||
| FaxNumber: | 7329016421 | ||||||||
| Practice Location | |||||||||
| Address1: | 231 3RD ST | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087013220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323642500 | ||||||||
| FaxNumber: | 7329140470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 02/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | VAN DE ZILVER | ||||||||
| AuthorizedOfficialFirstName: | CRYSTAL | ||||||||
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| AuthorizedOfficialTitleorPosition: | EMS CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 7329018487 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | NJ | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 6125905 | 05 | NJ | MEDICAID |