Provider Demographics
NPI:1174677264
Name:CORPORATE CARE
Entity Type:Organization
Organization Name:CORPORATE CARE
Other - Org Name:KIMBALL MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:V.P. OF MEDICAL AFFAIRS
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOMBARDINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-363-1900
Mailing Address - Street 1:415 BIRCH BARK DR
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-4903
Mailing Address - Country:US
Mailing Address - Phone:732-477-3334
Mailing Address - Fax:732-477-3334
Practice Address - Street 1:500 RIVER AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4721
Practice Address - Country:US
Practice Address - Phone:732-363-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN08747500261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center