Lake, Eric J

Lake, Eric J is an individual health care provider with primary practice located at 525 W Chester Pike Suite 203, Havertown PA 19083-4500. He recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as his primary health care specialty. Lake, Eric J can be contacted via phone (610) 789-7767.

Contact Information

Primary practice address
525 W Chester Pike Suite 203 Havertown PA 19083-4500
Phone: (610) 789-7767
Fax: (610) 789-7768
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X OS012275 Pennsylvania

Profile Details

NPI number 1710919139
LBN Legal business name Lake, Eric J
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 7th, 2006
Last updated Jul 18th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710919139 NPPES
Pennsylvania MEDICAID 1016353100001

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