Provider Demographics
NPI:1396761979
Name:LODI MEDICAL CENTER
Entity type:Organization
Organization Name:LODI MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOCAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:973-777-3130
Mailing Address - Street 1:4 HUNTER ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-1608
Mailing Address - Country:US
Mailing Address - Phone:973-777-3130
Mailing Address - Fax:973-777-3134
Practice Address - Street 1:999 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2711
Practice Address - Country:US
Practice Address - Phone:973-777-7879
Practice Address - Fax:973-777-6738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA42726207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty