Organization
EASTERN THORACIC SURGICAL ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOURENS J WILLEKES II M.D. (PHYSICIAN)
(732) 741-9980
Entity
Organization
Contact information
Practice address
65 MECHANIC ST, SUITE 102, RED BANK, NJ 07701-1869
(732) 741-9980
(732) 741-9982
Mailing address
65 MECHANIC ST, SUITE 102, RED BANK, NJ 07701-1869
(732) 741-9980
(732) 741-9982
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0077411
—
NJ
Enumeration date
04/17/2008
Last updated
07/24/2009
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