Basic Information
| Provider Information | |||||||||
| NPI: | 1144697822 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIFECARE PHYSICIANS, P.C. | ||||||||
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| OtherOrganizationName: | LIFECARE PHYSICIANS OF HAMILTON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 GROVE ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HADDON HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080351761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567969200 | ||||||||
| FaxNumber: | 8567969397 | ||||||||
| Practice Location | |||||||||
| Address1: | 1225 WHITEHORSE MERCERVILLE RD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | HAMILTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086193882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095816060 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2015 | ||||||||
| LastUpdateDate: | 08/28/2015 | ||||||||
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| AuthorizedOfficialLastName: | KELLY | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP FINANCE/ CFO | ||||||||
| AuthorizedOfficialTelephone: | 6095995036 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LIFECARE PHYSICIANS, P.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.