Provider Demographics
NPI:1912236068
Name:LIGHTHOUSE PRIMARY CARE SERVICES, LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE PRIMARY CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:609-597-5636
Mailing Address - Street 1:282 LIGHTHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2530
Mailing Address - Country:US
Mailing Address - Phone:609-597-5636
Mailing Address - Fax:609-597-5631
Practice Address - Street 1:1173 BEACON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2420
Practice Address - Country:US
Practice Address - Phone:609-597-5636
Practice Address - Fax:609-597-5631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00071700261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care