Provider Demographics
NPI:1710221346
Name:TRICOUNTY PHYSICIAN HOMECARE LLC
Entity Type:Organization
Organization Name:TRICOUNTY PHYSICIAN HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LUKENDA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:908-925-9309
Mailing Address - Street 1:716 NEWMAN SPRINGS RD
Mailing Address - Street 2:BOX 231
Mailing Address - City:LINCROFT
Mailing Address - State:NJ
Mailing Address - Zip Code:07738-1523
Mailing Address - Country:US
Mailing Address - Phone:908-925-9309
Mailing Address - Fax:908-925-7910
Practice Address - Street 1:716 NEWMAN SPRINGS RD
Practice Address - Street 2:BOX 231
Practice Address - City:LINCROFT
Practice Address - State:NJ
Practice Address - Zip Code:07738-1523
Practice Address - Country:US
Practice Address - Phone:908-925-9309
Practice Address - Fax:908-925-7910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MBO5511300207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty