Provider Demographics
NPI:1629016969
Name:LUGO, CARMELO (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMELO
Middle Name:
Last Name:LUGO
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 1:6040 BLVD EAST
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-3825
Mailing Address - Country:US
Mailing Address - Phone:201-996-5994
Mailing Address - Fax:
Practice Address - Street 1:60 2ND ST
Practice Address - Street 2:DEPT OF PSYCH
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2050
Practice Address - Country:US
Practice Address - Phone:201-996-5994
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA060212002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF51753Medicare UPIN
NJ505201Medicare ID - Type Unspecified