Healthcare Provider Details

I. General information

NPI: 1861441966
Provider Name (Legal Business Name): PASQUALE A. LUCIANO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BRACE RD STE H
CHERRY HILL NJ
08034-2600
US

IV. Provider business mailing address

23 LAMSON LN
SEWELL NJ
08080-1897
US

V. Phone/Fax

Practice location:
  • Phone: 856-547-0389
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MB05403700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number25MB05403700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: