Provider Demographics
NPI:1710047733
Name:LLACUNA, FLORENCIO VINALON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:FLORENCIO
Middle Name:VINALON
Last Name:LLACUNA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1100 CLIFTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013
Mailing Address - Country:US
Mailing Address - Phone:973-594-8444
Mailing Address - Fax:973-773-4491
Practice Address - Street 1:1100 CLIFTON AVENUE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013
Practice Address - Country:US
Practice Address - Phone:973-594-8444
Practice Address - Fax:973-773-4491
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05807300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5598109Medicaid
743337Medicare ID - Type Unspecified
NJ5598109Medicaid