Provider Demographics
NPI:1154640092
Name:CARLA LUCACEL MD PC
Entity Type:Organization
Organization Name:CARLA LUCACEL MD PC
Other - Org Name:SUNNYSIDE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:ADRIANA
Authorized Official - Last Name:LUCACEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-482-6814
Mailing Address - Street 1:4224 GREENPOINT AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-3004
Mailing Address - Country:US
Mailing Address - Phone:718-482-6814
Mailing Address - Fax:718-482-6817
Practice Address - Street 1:4224 GREENPOINT AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-3004
Practice Address - Country:US
Practice Address - Phone:718-482-6814
Practice Address - Fax:718-482-6817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty