Healthcare Provider Details

I. General information

NPI: 1871562173
Provider Name (Legal Business Name): MICHELE P. TUCK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 CRANBURY RD
EAST BRUNSWICK NJ
08816-3612
US

IV. Provider business mailing address

503 CRANBURY RD
EAST BRUNSWICK NJ
08816-3612
US

V. Phone/Fax

Practice location:
  • Phone: 732-390-8400
  • Fax:
Mailing address:
  • Phone: 732-390-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMA069507
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: