Provider Demographics
NPI:1013089499
Name:LAKEWOOD SURGICAL GROUP PA
Entity Type:Organization
Organization Name:LAKEWOOD SURGICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRETTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-341-0470
Mailing Address - Street 1:9 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE C23
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6425
Mailing Address - Country:US
Mailing Address - Phone:732-341-0470
Mailing Address - Fax:732-341-0473
Practice Address - Street 1:9 HOSPITAL DRIVE
Practice Address - Street 2:SUITE C23
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6425
Practice Address - Country:US
Practice Address - Phone:732-341-0470
Practice Address - Fax:732-341-0473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1018813OtherNEW JERSEY HEALTH
NJCA6841OtherRR MEDICARE
NJ169045OtherUNITEDHEALTHCARE
NJ0099331000OtherAMERIHEALTH
NJ0112415OtherAETNA HMO
NJ0099331000OtherAMERIHEALTH