Healthcare Provider Details

I. General information

NPI: 1194261347
Provider Name (Legal Business Name): JAIMIE LUKACS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 10TH ST
SECAUCUS NJ
07094-2921
US

IV. Provider business mailing address

624 FERN ST
TOWNSHIP OF WASHINGTON NJ
07676-4434
US

V. Phone/Fax

Practice location:
  • Phone: 201-863-3346
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NJ00683200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: