Provider Demographics
NPI:1053048496
Name:J P L TLC 76 &3 CORP
Entity type:Organization
Organization Name:J P L TLC 76 &3 CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMENDOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-816-6500
Mailing Address - Street 1:7524 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3104
Mailing Address - Country:US
Mailing Address - Phone:718-816-6500
Mailing Address - Fax:718-816-4677
Practice Address - Street 1:7524 3RD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3104
Practice Address - Country:US
Practice Address - Phone:718-816-6500
Practice Address - Fax:718-816-4677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty