Provider Demographics
NPI:1295513273
Name:LAKEWOOD UROLOGY LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:LAKEWOOD UROLOGY LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MOAZAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GAZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-838-9941
Mailing Address - Street 1:1374 WHITEHORSE HAMILTON SQUARE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3701
Mailing Address - Country:US
Mailing Address - Phone:609-581-5900
Mailing Address - Fax:
Practice Address - Street 1:780 ROUTE 37 W STE 235
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5065
Practice Address - Country:US
Practice Address - Phone:732-286-6644
Practice Address - Fax:732-286-9321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site