Provider Demographics
NPI:1730363128
Name:LAKEVIEW MEDICAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:LAKEVIEW MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LEGGIERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-691-1111
Mailing Address - Street 1:125 U.S. HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:BUDD LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07828
Mailing Address - Country:US
Mailing Address - Phone:973-691-1111
Mailing Address - Fax:973-691-1198
Practice Address - Street 1:125 U.S. HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:BUDD LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07828
Practice Address - Country:US
Practice Address - Phone:973-691-1111
Practice Address - Fax:973-691-1198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05955600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty