Provider Demographics
NPI:1750645990
Name:THE LENNARD CLINIC, INC.
Entity Type:Organization
Organization Name:THE LENNARD CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUGHINGHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-596-2850
Mailing Address - Street 1:850 WOODRUFF LN
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-2022
Mailing Address - Country:US
Mailing Address - Phone:908-352-0850
Mailing Address - Fax:908-352-1036
Practice Address - Street 1:850 WOODRUFF LN
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2022
Practice Address - Country:US
Practice Address - Phone:908-352-0850
Practice Address - Fax:908-352-1036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2000417261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0099911Medicaid
NJ7604009Medicaid