Organization
LACEY MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANN DIPAOLO DO (OWNER)
(609) 693-0819
Entity
Organization
Contact information
Practice address
1044 LACEY RD STE 9, FORKED RIVER, NJ 08731-1051
(609) 693-0819
(609) 971-0834
Mailing address
1044 LACEY RD STE 9, FORKED RIVER, NJ 08731-1051
(609) 693-0819
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MB07677400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0052680
—
NJ
Enumeration date
05/31/2013
Last updated
10/12/2023
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