Provider Demographics
NPI:1295083525
Name:LFT FAMILY MEDICINE & PAIN MANAGEMENT
Entity type:Organization
Organization Name:LFT FAMILY MEDICINE & PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPRINCE
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:856-768-7737
Mailing Address - Street 1:PO BOX 19
Mailing Address - Street 2:
Mailing Address - City:CEDAR BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08018-0019
Mailing Address - Country:US
Mailing Address - Phone:609-704-1857
Mailing Address - Fax:609-704-1859
Practice Address - Street 1:403 COMMERCE LN
Practice Address - Street 2:
Practice Address - City:WEST BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08091-2513
Practice Address - Country:US
Practice Address - Phone:856-768-7737
Practice Address - Fax:856-768-4477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0089071208VP0000X
NJ25MB06561000208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty