87TH Medgrp-JB McGuire-Dix-Lakehurst

Primary specialty

Military/U.S. Coast Guard Outpatient Clinic/CenterTaxonomy code 261QM1100X

Legal business name

87TH MEDGRP-JB MCGUIRE-DIX-LAKEHURST

Practice address

3458 Neely Rd
MDSS Sgsbr
MC Guire Afb, NJ 08641-5312

Phone

(609) 754-9658

Fax

(609) 754-9541

NPI assigned

Apr 25, 2006

Organization subpart

Yes

Parent organization

87TH MEDGRP-JB MCGUIRE-DIX-LAKEHURSTAs reported in NPPES

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

Authorized official

Name

Jen Lewandowski

Title

Dha Ubo

Phone

(703) 817-4030

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• JB McGuire-Dix-Lakehurst MTF Other name

Tax ID family

87TH Medgrp-JB McGuire-Dix-Lakehurst2 organizations share this tax ID, including this one

Part of

87TH Medgrp-JB McGuire-Dix-Lakehurst

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• 87TH Medgrp-JB McGuire-Dix-Lakehurst

  • Military/U.S. Coast Guard Pharmacy
  • Joint Base MDL, NJ
  • NPI 1427465889
  NPD tax ID

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750118400000",
    "number": "1881650141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3458 NEELY RD",
            "address_2": "MDSS SGSBR",
            "city": "MC GUIRE AFB",
            "state": "NJ",
            "postal_code": "086415312",
            "telephone_number": "609-754-9658",
            "fax_number": "609-754-9541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3458 NEELY RD",
            "address_2": "MDSS SGSBR",
            "city": "MC GUIRE AFB",
            "state": "NJ",
            "postal_code": "086415312",
            "telephone_number": "609-754-9658",
            "fax_number": "609-754-9541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "87TH MEDGRP-JB MCGUIRE-DIX-LAKEHURST",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "87TH MEDGRP-JB MCGUIRE-DIX-LAKEHURST",
        "enumeration_date": "2006-04-25",
        "last_updated": "2025-06-17",
        "certification_date": "2025-06-17",
        "status": "A",
        "authorized_official_last_name": "LEWANDOWSKI",
        "authorized_official_first_name": "JEN",
        "authorized_official_title_or_position": "DHA UBO",
        "authorized_official_telephone_number": "703-817-4030"
    },
    "taxonomies": [
        {
            "code": "261QM1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military/U.S. Coast Guard Outpatient",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1101X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Military and U.S. Coast Guard Ambulatory Procedure",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332000000X",
            "taxonomy_group": "",
            "desc": "Military/U.S. Coast Guard Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "31-41847",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JB McGuire-Dix-Lakehurst MTF",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Amanda Ammentorp, DO
• Jess Barrows, LCSW, LCADC
• Stacey Keane Boden, LICSW
• Deon Bullard, MSW, LCSW
• Daniel Castiglia, R.PH.

• Military/U.S. Coast Guard Outpatient Clinic/Center in MC Guire Afb, NJ
• Providers in MC Guire Afb, NJ by specialty
• Military/U.S. Coast Guard Outpatient Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.