Healthcare Provider Details

I. General information

NPI: 1174511232
Provider Name (Legal Business Name): ESTELA V LACAP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 SCHANCK RD
FREEHOLD NJ
07728-2974
US

IV. Provider business mailing address

222 SCHANCK RD
FREEHOLD NJ
07728-2974
US

V. Phone/Fax

Practice location:
  • Phone: 732-431-3373
  • Fax: 732-303-0172
Mailing address:
  • Phone: 732-431-3373
  • Fax: 732-303-0172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA69154
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: