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NPI Code Detail

MEDICARE: MS. JUDITH ANN LACINAK APN-C

MEDICARE: MS. JUDITH ANN LACINAK APN-C
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
1363LA2200XAdult Health Nurse Practitioner26NJ00119400NJ

General Provider Information

NPI Number : 1275623316
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JUDITH ANN LACINAK APN-C
Provider Business Mailing Address
First Line : 175 BILTMORE ST
Second Line :
City : NORTH ARLINGTON
State : NJ
Zip : 07031-5609
Country : US
Telephone Number : 201-997-3094
Fax Number :
Provider Business Practice Location Address
First Line : 298 BROADWAY
Second Line :
City : NEWARK
State : NJ
Zip : 07104-4003
Country : US
Telephone Number : 973-268-9797
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 07/08/2007

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