Provider Demographics
NPI:1174511232
Name:LACAP, ESTELA V (MD)
Entity Type:Individual
Prefix:
First Name:ESTELA
Middle Name:V
Last Name:LACAP
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 1:222 SCHANCK RD
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2974
Mailing Address - Country:US
Mailing Address - Phone:732-431-3373
Mailing Address - Fax:732-303-0172
Practice Address - Street 1:222 SCHANCK RD
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2974
Practice Address - Country:US
Practice Address - Phone:732-431-3373
Practice Address - Fax:732-303-0172
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA69154208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7972202Medicaid
NJG96527Medicare UPIN