1972565844 NPI number — DR. LAURENCE JOHN LEMBACH DPM

Table of content: DOUGLAS F CATOGGIO D.C. (NPI 1306987326)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972565844 NPI number — DR. LAURENCE JOHN LEMBACH DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEMBACH
Provider First Name:
LAURENCE
Provider Middle Name:
JOHN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972565844
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13535 DETROIT AVE
Provider Second Line Business Mailing Address:
SUITE 7
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44107-4625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-226-2444
Provider Business Mailing Address Fax Number:
216-226-3112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13535 DETROIT AVE
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44107-4625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-226-2444
Provider Business Practice Location Address Fax Number:
216-226-3112
Provider Enumeration Date:
04/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X , with the licence number:  36001762 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P35653478 . This is a "PRINCIPAL MULTI PLAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0310425 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 55396 . This is a "QUALCHOICE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 10196 . This is a "KAISER PERMANENTE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2700750 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 791480328 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000143072 . This is a "ANTHEM BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 346747145026 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: L01762 . This is a "SUMMACARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0004297638 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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