Provider Demographics
NPI:1164496147
Name:LUCCO, JULIANNE (MD)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:LUCCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 FRENCHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08848-1329
Mailing Address - Country:US
Mailing Address - Phone:908-995-2251
Mailing Address - Fax:
Practice Address - Street 1:200 FRENCHTOWN RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:08848-1329
Practice Address - Country:US
Practice Address - Phone:908-995-2251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06630900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4135202Medicaid
NJ027494B6DMedicare ID - Type Unspecified
NJ4135202Medicaid