Healthcare Provider Details

I. General information

NPI: 1023214178
Provider Name (Legal Business Name): ALAN NICOLO LUCERNA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 E LAUREL RD
STRATFORD NJ
08084-1327
US

IV. Provider business mailing address

1204 HARWOOD CT
MOUNT LAUREL NJ
08054-2612
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-6859
  • Fax:
Mailing address:
  • Phone: 856-273-8967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MB08637900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: