Provider Demographics
NPI:1306322839
Name:LC MEDICAL CARE LLC
Entity type:Organization
Organization Name:LC MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CORRENTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-899-3560
Mailing Address - Street 1:335 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07648-0001
Mailing Address - Country:US
Mailing Address - Phone:201-899-3560
Mailing Address - Fax:201-899-3561
Practice Address - Street 1:335 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07648-0001
Practice Address - Country:US
Practice Address - Phone:201-899-3560
Practice Address - Fax:201-899-3561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08886400208VP0000X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty