Provider Demographics
NPI:1942214432
Name:LUCENTE, RICHARD JR (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:LUCENTE
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 MASON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3417
Mailing Address - Country:US
Mailing Address - Phone:718-668-2340
Mailing Address - Fax:718-668-2523
Practice Address - Street 1:271 MASON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3417
Practice Address - Country:US
Practice Address - Phone:718-668-2340
Practice Address - Fax:718-668-2523
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215528207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02151953Medicaid
H28341Medicare UPIN
NY02151953Medicaid