Provider Demographics
NPI:1104699032
Name:WOODLAKE OCCUPATIONAL HEALTH LLC
Entity type:Organization
Organization Name:WOODLAKE OCCUPATIONAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSET MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHAIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-522-5970
Mailing Address - Street 1:150 AIRPORT RD STE 900
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-6988
Mailing Address - Country:US
Mailing Address - Phone:516-668-9675
Mailing Address - Fax:
Practice Address - Street 1:1111 SUPERIOR ST STE 506
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-4156
Practice Address - Country:US
Practice Address - Phone:708-919-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine