1760443030 NPI number — DR. ANTHONY JOSEPH LUCATORTO D.O.

Table of content: DR. ANTHONY JOSEPH LUCATORTO D.O. (NPI 1760443030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760443030 NPI number — DR. ANTHONY JOSEPH LUCATORTO D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUCATORTO
Provider First Name:
ANTHONY
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
1760443030
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28 BOWLING GREEN PARKWAY
Provider Second Line Business Mailing Address:
SUITE LL3
Provider Business Mailing Address City Name:
LAKE HOPATCONG
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07849-2445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-663-8899
Provider Business Mailing Address Fax Number:
973-663-9511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28 BOWLING GREEN PARKWAY
Provider Second Line Business Practice Location Address:
SUITE LL3
Provider Business Practice Location Address City Name:
LAKE HOPATCONG
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07849-2445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-214-8679
Provider Business Practice Location Address Fax Number:
973-663-9511
Provider Enumeration Date:
03/28/2006

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: 207Q00000X , with the licence number:  25MB06095000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P376680 . This is a "OXFORD HEALTH PLAN ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0811246000 . This is a "AMERIHEALTH HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 200563432 . This is a "BCBS FEDERAL EMPLOYEE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 000786118 . This is a "HIGHMARK BLUE SHIELD ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 200563432 . This is a "UNITED HEALTHCARE ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 200563432 . This is a "QUALCARE PPO HMO ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2355303001 . This is a "AMERIHEALTH HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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