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General NPI Number Information
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NPI Number | 1881978351
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Entity Type | Organization
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Legal Business Name | LUCILA MEDICAL PC
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Dates
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Enumeration Date | 10/03/2011
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Last Update Date | 10/03/2011
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Provider Practice Location Address
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Address Line | 780 ALLWOOD RD
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City | CLIFTON
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State | NJ
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Zip | 07012-1923
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Country | US
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Telephone | 973-249-6202
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Fax | 973-249-6203
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Provider Business Mailing Address
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Address Line | 780 ALLWOOD RD
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City | CLIFTON
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State | NJ
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Zip | 07012-1923
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Country | US
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Telephone | 973-249-6202
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Fax | 973-249-6203
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Authorized Official
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Title or Position | CEO
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Name | DR. RAFAEL R V LUCILA
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Credential | M.D.
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Telephone | 973-249-6202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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