Provider Demographics
NPI:1265474852
Name:LAKIN, JEFFREY FRED (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:FRED
Last Name:LAKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:642 BROAD ST
Mailing Address - Street 2:STE 4
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013
Mailing Address - Country:US
Mailing Address - Phone:973-365-1139
Mailing Address - Fax:973-365-1664
Practice Address - Street 1:642 BROAD ST
Practice Address - Street 2:STE 4
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013
Practice Address - Country:US
Practice Address - Phone:973-365-1139
Practice Address - Fax:973-365-1664
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA048918207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJLA067099Medicare ID - Type Unspecified
F34755Medicare UPIN