MEDICARE: DR. GRACIANO LUCERO ZARA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	25MA06494900	NJ
2	207R00000X	Internal Medicine Physician	25MA06494900	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225188543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRACIANO LUCERO ZARA MD

Provider Business Mailing Address
First Line	:	137 LIVINGSTON AVENUE
Second Line	:
City	:	NEW BRUNSWICK
State	:	NJ
Zip	:	08901
Country	:	US
Telephone Number	:	732-545-0051
Fax Number	:

Provider Business Practice Location Address
First Line	:	137 LIVINGSTON AVE
Second Line	:
City	:	NEW BRUNSWICK
State	:	NJ
Zip	:	08901-2497
Country	:	US
Telephone Number	:	732-390-8161
Fax Number	:	732-390-6110

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	07/13/2022

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