Provider Demographics
NPI:1932382769
Name:LADY K LINGERIE INC.
Entity Type:Organization
Organization Name:LADY K LINGERIE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHLEEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:WALRAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:973-627-1836
Mailing Address - Street 1:33 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2705
Mailing Address - Country:US
Mailing Address - Phone:973-627-1836
Mailing Address - Fax:973-627-7105
Practice Address - Street 1:33 BROADWAY
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2705
Practice Address - Country:US
Practice Address - Phone:973-627-1836
Practice Address - Fax:973-627-7105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-16
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0550910001Medicare NSC