Provider Demographics
NPI:1538408281
Name:ENCORE MEDICAL STAFFING NORTHEAST
Entity type:Organization
Organization Name:ENCORE MEDICAL STAFFING NORTHEAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKERNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:267-288-5212
Mailing Address - Street 1:639 E MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-4640
Mailing Address - Country:US
Mailing Address - Phone:267-288-5212
Mailing Address - Fax:215-355-7550
Practice Address - Street 1:639 E MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-4640
Practice Address - Country:US
Practice Address - Phone:267-288-5212
Practice Address - Fax:215-355-7550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA23473601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health