MEDICARE: LUCIA P CARUANA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	25MA05815900	NJ

General Provider Information

NPI Number	:	1215975453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCIA P CARUANA M.D.

Provider Business Mailing Address
First Line	:	704 PALISADE AVE
Second Line	:
City	:	TEANECK
State	:	NJ
Zip	:	07666-3144
Country	:	US
Telephone Number	:	201-836-4301
Fax Number	:	201-530-7337

Provider Business Practice Location Address
First Line	:	704 PALISADE AVE
Second Line	:
City	:	TEANECK
State	:	NJ
Zip	:	07666-3144
Country	:	US
Telephone Number	:	201-836-4301
Fax Number	:	201-836-5110

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	07/03/2013

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