Provider Demographics
NPI:1821044397
Name:LUCRECIA ALBURQUERQUE MD PA
Entity Type:Organization
Organization Name:LUCRECIA ALBURQUERQUE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCRECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBURQUERQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-684-1302
Mailing Address - Street 1:412 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07504-1930
Mailing Address - Country:US
Mailing Address - Phone:973-684-1302
Mailing Address - Fax:
Practice Address - Street 1:412 PARK AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07504-1930
Practice Address - Country:US
Practice Address - Phone:973-684-1302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA34005174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0314005Medicaid
NJ0314005Medicaid