Provider Demographics
NPI:1467418665
Name:LIGHTER FOR LIFE
Entity Type:Organization
Organization Name:LIGHTER FOR LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMELGARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-523-6185
Mailing Address - Street 1:140 N RTE 17
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2809
Mailing Address - Country:US
Mailing Address - Phone:201-523-6185
Mailing Address - Fax:
Practice Address - Street 1:140 N RTE 17
Practice Address - Street 2:SUITE 102
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2809
Practice Address - Country:US
Practice Address - Phone:201-523-6185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06782900208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty