| Organization Name: | MOUNTAIN LAKES MEDICAL CENTER, LLC |
| NPI Number: | 1457585556 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RICHARD JOSEPH SCHWEITZER (PRESIDENT) |
| Mailing Address: | 100 Route 46 E Building B, Suite 204 Mountain Lakes |
| State: | NJ US |
| Postal Code: | 070461745 |
| Phone Number: | 9739173200 |
| Fax Number: | 9739173201 |
| NPI Enumeration Date: | 05/05/2009 |
| NPI Last Update Date: | 12/11/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | 25MA07139700 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |