Healthcare Provider Details

I. General information

NPI: 1720697188
Provider Name (Legal Business Name): LUCY JOSEPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 KENT RD
HOWELL NJ
07731-2452
US

IV. Provider business mailing address

5 HILLTOP DR
MOUNT LAUREL NJ
08054-4825
US

V. Phone/Fax

Practice location:
  • Phone: 732-367-1535
  • Fax:
Mailing address:
  • Phone: 224-622-3646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSPO22211
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01101500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: