1457344012 NPI number — DR. JUDITH ANNE LUCAS M.D.

Table of content: JENNIFER O'CONNELL (NPI 1801174297)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457344012 NPI number — DR. JUDITH ANNE LUCAS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUCAS
Provider First Name:
JUDITH
Provider Middle Name:
ANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457344012
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
391 MYRTLE AVE
Provider Second Line Business Mailing Address:
SUITE 3B
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-262-5401
Provider Business Mailing Address Fax Number:
518-262-4450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
391 MYRTLE AVE
Provider Second Line Business Practice Location Address:
SUITE 3B
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-262-5401
Provider Business Practice Location Address Fax Number:
518-262-4450
Provider Enumeration Date:
08/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0006X , with the licence number:  198646 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01585717 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com