Provider Demographics
NPI:1730296211
Name:RAFAEL R.V. LUCILA MD
Entity Type:Organization
Organization Name:RAFAEL R.V. LUCILA MD
Other - Org Name:LUCILA MEDICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:RV
Authorized Official - Last Name:LUCILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-249-6202
Mailing Address - Street 1:780 ALLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1923
Mailing Address - Country:US
Mailing Address - Phone:973-249-6202
Mailing Address - Fax:973-249-6203
Practice Address - Street 1:780 ALLWOOD RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1923
Practice Address - Country:US
Practice Address - Phone:973-249-6202
Practice Address - Fax:973-249-6203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA061330207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6672001Medicaid
NJ506116Medicare ID - Type Unspecified
NJ6672001Medicaid