Provider Demographics
NPI:1083471148
Name:LUCAS, SYREETA (PHLEBOTOMY)
Entity Type:Individual
Prefix:MRS
First Name:SYREETA
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PHLEBOTOMY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 HOLLYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-2715
Mailing Address - Country:US
Mailing Address - Phone:908-906-6077
Mailing Address - Fax:
Practice Address - Street 1:437 HOLLYWOOD AVE
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205-2715
Practice Address - Country:US
Practice Address - Phone:908-906-6077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22117344246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy