Provider Demographics
NPI:1831605435
Name:LENOX MEDICAL GROUP
Entity type:Organization
Organization Name:LENOX MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:FADIPE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:732-686-6030
Mailing Address - Street 1:1600 SAINT GEORGES AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-2713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 SAINT GEORGES AVE STE 111
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-2713
Practice Address - Country:US
Practice Address - Phone:732-686-6030
Practice Address - Fax:732-453-6171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00468500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty