Provider Demographics
NPI:1629474697
Name:LUCIK, ANGELA (PA-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:LUCIK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGS WAY E
Mailing Address - Street 2:STE A3
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2237
Mailing Address - Country:US
Mailing Address - Phone:215-639-7546
Mailing Address - Fax:
Practice Address - Street 1:1950 STREET RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-3755
Practice Address - Country:US
Practice Address - Phone:215-639-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA416717ZPA2Medicare PIN