Provider Demographics
NPI:1043252356
Name:LAKELAND UROLOGY L L C
Entity Type:Organization
Organization Name:LAKELAND UROLOGY L L C
Other - Org Name:LAKELAND UROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:CUBELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-627-3411
Mailing Address - Street 1:16 POCONO RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2901
Mailing Address - Country:US
Mailing Address - Phone:973-627-3411
Mailing Address - Fax:973-627-1095
Practice Address - Street 1:16 POCONO RD
Practice Address - Street 2:SUITE 302
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2901
Practice Address - Country:US
Practice Address - Phone:973-627-3411
Practice Address - Fax:973-627-1095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty