Provider Demographics
NPI:1356569388
Name:LAKEWOOD UROLOGY LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:LAKEWOOD UROLOGY LIMITED LIABILITY COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUKARAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-581-5900
Mailing Address - Street 1:1374 WHITEHORSE HAMILTON SQUARE RD
Mailing Address - Street 2:SUITE 101
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:609-581-5901
Practice Address - Street 1:1374 WHITEHORSE HAMILTON SQUARE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3701
Practice Address - Country:US
Practice Address - Phone:609-581-5900
Practice Address - Fax:609-581-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0019429Medicaid
NJP2564828OtherOXFORD
NJ91001110700OtherAMERICHOICE
NJ2636882000OtherAMERIHEALTH
NJ2958547OtherAETNA
NJ2K5726OtherHEALTHNET
NJP2564828OtherOXFORD