Healthcare Provider Details

I. General information

NPI: 1104764083
Provider Name (Legal Business Name): LUCILLE MIAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 HOES LN W # D325
PISCATAWAY NJ
08854-8021
US

IV. Provider business mailing address

19 SPRUCE HOLLOW RD
GREEN BROOK NJ
08812-1835
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-4433
  • Fax:
Mailing address:
  • Phone: 732-850-3023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: