Provider Demographics
NPI:1457585556
Name:MOUNTAIN LAKES MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:MOUNTAIN LAKES MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SCHWEITZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-917-3200
Mailing Address - Street 1:100 ROUTE 46 E
Mailing Address - Street 2:BUILDING B, SUITE 204
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1745
Mailing Address - Country:US
Mailing Address - Phone:973-917-3200
Mailing Address - Fax:973-917-3201
Practice Address - Street 1:100 ROUTE 46 E
Practice Address - Street 2:BUILDING B, SUITE 204
Practice Address - City:MOUNTAIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07046-1745
Practice Address - Country:US
Practice Address - Phone:973-917-3200
Practice Address - Fax:973-917-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07139700261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ163185OtherMEDICARE PTAN
NJ6728370001Medicare NSC