Provider Demographics
NPI:1497874838
Name:TRI COUNTY PHYSICIAN HOMECARE
Entity Type:Organization
Organization Name:TRI COUNTY PHYSICIAN HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LUKENDA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:908-925-9309
Mailing Address - Street 1:PO BOX 231
Mailing Address - Street 2:
Mailing Address - City:LINCROFT
Mailing Address - State:NJ
Mailing Address - Zip Code:07738-0231
Mailing Address - Country:US
Mailing Address - Phone:908-925-9309
Mailing Address - Fax:908-925-7910
Practice Address - Street 1:850 N WOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-4038
Practice Address - Country:US
Practice Address - Phone:908-925-9309
Practice Address - Fax:908-925-7910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB55113207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ714815Medicare ID - Type Unspecified