Provider Demographics
NPI:1194317701
Name:EASTERN PHYSICAL MEDICINE AND WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:EASTERN PHYSICAL MEDICINE AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNDON
Authorized Official - Middle Name:
Authorized Official - Last Name:CAGAMPAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-535-1951
Mailing Address - Street 1:106 HAMPTON HILL DR
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:DE
Mailing Address - Zip Code:19934-5301
Mailing Address - Country:US
Mailing Address - Phone:302-535-1951
Mailing Address - Fax:
Practice Address - Street 1:1009 MATTLIND WAY
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-5369
Practice Address - Country:US
Practice Address - Phone:302-535-1951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Multi-Specialty