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General NPI Number Information
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NPI Number | 1194261347
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Entity Type | Individual
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Provider Name | JAIMIE LUKACS
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Gender | Female
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Dates
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Enumeration Date | 01/12/2017
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Last Update Date | 01/12/2017
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Provider Practice Location Address
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Address Line | 714 10TH ST
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City | SECAUCUS
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State | NJ
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Zip | 07094-2921
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Country | US
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Telephone | 201-863-3346
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Fax |
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Provider Business Mailing Address
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Address Line | 624 FERN ST
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City | TOWNSHIP OF WASHINGTON
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State | NJ
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Zip | 07676-4434
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 26NJ00683200
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License Number State | NJ
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