Provider Demographics
NPI:1770802829
Name:DR JEROME J LAMENDOLA LLC
Entity type:Organization
Organization Name:DR JEROME J LAMENDOLA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLECAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-529-1800
Mailing Address - Street 1:15810 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3711
Mailing Address - Country:US
Mailing Address - Phone:216-529-1800
Mailing Address - Fax:216-529-3201
Practice Address - Street 1:29101 HEALTH CAMPUS DR BLDG 2
Practice Address - Street 2:#255
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5270
Practice Address - Country:US
Practice Address - Phone:216-529-1800
Practice Address - Fax:216-529-3201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR JEROME J LAMENDOLA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-27
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002157213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3086360Medicaid
OH9389491Medicare PIN
OHDQ5372Medicare PIN
OH6440970002Medicare NSC