Provider Demographics
NPI:1740533090
Name:LICE LIFTERS MARLTON NJ
Entity type:Organization
Organization Name:LICE LIFTERS MARLTON NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:BUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-334-5591
Mailing Address - Street 1:4001 LINCOLN DR W
Mailing Address - Street 2:SUITE H
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1525
Mailing Address - Country:US
Mailing Address - Phone:856-334-5591
Mailing Address - Fax:
Practice Address - Street 1:4001 LINCOLN DR W
Practice Address - Street 2:SUITE H
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1525
Practice Address - Country:US
Practice Address - Phone:856-334-5591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service