Provider Demographics
NPI:1154640217
Name:DR JEROME J LAMENDOLA LLC
Entity Type:Organization
Organization Name:DR JEROME J LAMENDOLA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLECAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-529-1800
Mailing Address - Street 1:15810 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3711
Mailing Address - Country:US
Mailing Address - Phone:216-529-1800
Mailing Address - Fax:216-529-3201
Practice Address - Street 1:15810 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3711
Practice Address - Country:US
Practice Address - Phone:216-529-1800
Practice Address - Fax:216-529-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002157213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3068077Medicaid
OH9389491Medicare PIN
OH3068077Medicaid
OH6440970001Medicare NSC