Provider Demographics
NPI:1689004657
Name:DR LUCAS RALSTON MD
Entity Type:Organization
Organization Name:DR LUCAS RALSTON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAIN MANAGEMENT/ORTHOPEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RALSTON MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-277-8672
Mailing Address - Street 1:201 CEDAR GROVE RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-4332
Mailing Address - Country:US
Mailing Address - Phone:732-277-8672
Mailing Address - Fax:
Practice Address - Street 1:201 CEDAR GROVE RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-4332
Practice Address - Country:US
Practice Address - Phone:732-277-8672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ243938302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2084P0800XMedicaid