Healthcare Provider Details

I. General information

NPI: 1558020693
Provider Name (Legal Business Name): LYNDSAY DELUCA APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2021
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 CAMPUS PKWY
WALL TOWNSHIP NJ
07753-6821
US

IV. Provider business mailing address

419 SYLVANIA AVE
AVON BY THE SEA NJ
07717-2000
US

V. Phone/Fax

Practice location:
  • Phone: 732-751-7500
  • Fax:
Mailing address:
  • Phone: 908-433-0719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01227900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: