Provider Demographics
NPI:1053496224
Name:LUCAS, GEM-ESTELLE M (DO)
Entity Type:Individual
Prefix:
First Name:GEM-ESTELLE
Middle Name:M
Last Name:LUCAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:GEM
Other - Middle Name:M
Other - Last Name:LUCAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2100 WESCOTT DR.
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822
Mailing Address - Country:US
Mailing Address - Phone:908-788-6654
Mailing Address - Fax:908-788-6452
Practice Address - Street 1:190 RT. 31
Practice Address - Street 2:STE. 100
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822
Practice Address - Country:US
Practice Address - Phone:908-788-6654
Practice Address - Fax:908-788-6452
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB080296002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000847661OtherANTHEM BCBS
ININ1663060Medicare PIN