Healthcare Provider Details

I. General information

NPI: 1801073192
Provider Name (Legal Business Name): JOSEPH A. DELUCA, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PARK AVE SUITE 1A
LYNDHURST NJ
07071-1012
US

IV. Provider business mailing address

20 PARK AVE SUITE 1A
LYNDHURST NJ
07071-1012
US

V. Phone/Fax

Practice location:
  • Phone: 201-896-0096
  • Fax: 201-896-0062
Mailing address:
  • Phone: 201-896-0096
  • Fax: 201-896-0062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. NATALIE MARIA TAVARES
Title or Position: OFFICE MANAGER
Credential:
Phone: 201-896-0096