Provider Demographics
NPI:1164137790
Name:LASEMEDICA MEDSPA AND VEIN CENTER
Entity Type:Organization
Organization Name:LASEMEDICA MEDSPA AND VEIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REX
Authorized Official - Middle Name:
Authorized Official - Last Name:GHASSEMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-384-5365
Mailing Address - Street 1:600 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07762-2039
Mailing Address - Country:US
Mailing Address - Phone:732-384-5365
Mailing Address - Fax:
Practice Address - Street 1:600 WARREN AVE
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07762-2039
Practice Address - Country:US
Practice Address - Phone:732-384-5365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service