Provider Demographics
NPI:1689447088
Name:LUCINE, MICHAEL GODFREY
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GODFREY
Last Name:LUCINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 HIGHVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-8016
Mailing Address - Country:US
Mailing Address - Phone:201-417-7632
Mailing Address - Fax:
Practice Address - Street 1:54 HIGHVIEW AVE
Practice Address - Street 2:
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-8016
Practice Address - Country:US
Practice Address - Phone:201-417-7632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY391303-01163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health