Lake Physicians and Hospital Supply

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

0063901 Issued in NJ

Legal business name

LAKE PHYSICIANS AND HOSPITAL SUPPLY

Doing business as

Lake Surgical Supply

Practice address

92 Broadway
Denville, NJ 07834-2761

Phone

(973) 627-8100

Fax

(973) 627-4114

NPI assigned

Jul 19, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Carmen Michael Trezza

Title

Owner/President

Phone

(973) 627-8100

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lake Surgical Supply Doing business as

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209081600000",
    "number": "1083613269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "92 BROADWAY",
            "city": "DENVILLE",
            "state": "NJ",
            "postal_code": "078342761",
            "telephone_number": "973-627-8100",
            "fax_number": "973-627-4114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "92 BROADWAY",
            "city": "DENVILLE",
            "state": "NJ",
            "postal_code": "078342761",
            "telephone_number": "973-627-8100",
            "fax_number": "973-627-4114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE PHYSICIANS AND HOSPITAL SUPPLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-19",
        "last_updated": "2008-04-25",
        "status": "A",
        "authorized_official_last_name": "TREZZA",
        "authorized_official_first_name": "CARMEN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "973-627-8100"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NJ",
            "license": "0063901",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2580501",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Surgical Supply",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Phyllis Rita Lakin, PH.D,
• Richard Lally Joseph Lally, L.C.S.W.
• Paul C Lam, M.D.

• Durable Medical Equipment & Medical Supplies in Denville, NJ
• Providers in Denville, NJ by specialty
• Durable Medical Equipment & Medical Supplies in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.