Healthcare Provider Details

I. General information

NPI: 1073180550
Provider Name (Legal Business Name): GINA LUCARELLI WILBER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 RANDOLPH RD
HOWELL NJ
07731-8611
US

IV. Provider business mailing address

2021 ALBANY AVE
WEST HARTFORD CT
06117-2789
US

V. Phone/Fax

Practice location:
  • Phone: 866-415-8251
  • Fax:
Mailing address:
  • Phone: 860-570-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number005264
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5264
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: