Provider Demographics
NPI:1922077817
Name:ALBURQUERQUE, LUCRECIA (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCRECIA
Middle Name:
Last Name:ALBURQUERQUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:973-684-0144
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:973-684-0144
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA34005174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0314005Medicaid
NJ515486Medicare ID - Type Unspecified