Healthcare Provider Details

I. General information

NPI: 1982935987
Provider Name (Legal Business Name): LUKE R CAREY PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 US HIGHWAY 46 SUITE 400A
FAIRFIELD NJ
07004-1592
US

IV. Provider business mailing address

PO BOX 4059
WAYNE NJ
07474-4059
US

V. Phone/Fax

Practice location:
  • Phone: 973-826-8080
  • Fax: 866-309-3354
Mailing address:
  • Phone: 973-826-8080
  • Fax: 866-309-3354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00231000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC05070
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00231000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: