Basic Information
| Provider Information | |||||||||
| NPI: | 1356514715 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | L P CARES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 702 | ||||||||
| Address2: | |||||||||
| City: | BRIDGETON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 083020445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8564519395 | ||||||||
| FaxNumber: | 8564518615 | ||||||||
| Practice Location | |||||||||
| Address1: | TWO EIGHTH STREET | ||||||||
| Address2: | |||||||||
| City: | HAMMONTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080373347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889852727 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2008 | ||||||||
| LastUpdateDate: | 04/17/2009 | ||||||||
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| AuthorizedOfficialLastName: | PATHARKAR | ||||||||
| AuthorizedOfficialFirstName: | MILIND | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8564519395 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0158585 | 05 | NJ | MEDICAID |