Provider Demographics
NPI:1225188543
Name:ZARA, GRACIANO LUCERO (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACIANO
Middle Name:LUCERO
Last Name:ZARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 LIVINGSTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901
Mailing Address - Country:US
Mailing Address - Phone:732-545-0051
Mailing Address - Fax:
Practice Address - Street 1:137 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2497
Practice Address - Country:US
Practice Address - Phone:732-390-8161
Practice Address - Fax:732-390-6110
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06494900207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8101205Medicaid
NJ544538A02Medicare PIN
NJZA544538Medicare ID - Type Unspecified
NJ8101205Medicaid