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LOTUS INTEGRATED LONGEVITY ANTI-AGING CENTER INC. NPI 1497186167


NPI Information

NPI: 1497186167
Provider Name: LOTUS INTEGRATED LONGEVITY ANTI-AGING CENTER, INC.

Doing Business As: L.I.L.A.C.

Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 31D2041577

Address:
2301 E EVESHAM RD
VOORHEES, NJ
ZIP 08043
Phone: (856) 772-4971
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LOTUS INTEGRATED LONGEVITY ANTI-AGING CENTER, INC. is a specialist in Voorhees, NJ. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. LOTUS INTEGRATED LONGEVITY ANTI-AGING CENTER, INC. NPI is 1497186167. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As L.i.l.a.c..

The provider's business location address is:

2301 E EVESHAM RD
VOORHEES, NJ
ZIP 08043-501
Phone: (856) 772-4971
Fax: (856) 772-1140

The provider's authorized official is Epifania Cruz .
The authorized official title is Medical Director and has the following contact phone number (856) 772-4971.

The CLIA number assigned to this NPI record is 31D2041577 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/6/2013 and was last updated on 12/6/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1174400000XSpecialist25MA05996900NEW JERSEYYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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