Organization
LAKEWOOD CHILDREN'S CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL TYBERG MD (OWNER)
(917) 957-2273
Entity
Organization
Contact information
Practice address
8 LAKETREE CT, MANCHESTER, NJ 08759-5679
(917) 957-2273
Mailing address
8 LAKETREE CT, MANCHESTER, NJ 08759-5679
(917) 957-2273
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
11/13/2023
Last updated
11/13/2023
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