Provider Demographics
NPI:1144307166
Name:LAFAYETTE MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:LAFAYETTE MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:JULIE
Authorized Official - Last Name:CABALEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-344-3518
Mailing Address - Street 1:390 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-3125
Mailing Address - Country:US
Mailing Address - Phone:973-344-3518
Mailing Address - Fax:973-344-1167
Practice Address - Street 1:390 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-3125
Practice Address - Country:US
Practice Address - Phone:973-344-3518
Practice Address - Fax:973-344-1167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2018802Medicaid
NJ2018802Medicaid
NJF30834Medicare UPIN
NJ036158Medicare ID - Type Unspecified