Provider Demographics
NPI:1013352558
Name:OVINCY, LUCKNIE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:LUCKNIE
Middle Name:
Last Name:OVINCY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 S BURNETT ST
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2502
Mailing Address - Country:US
Mailing Address - Phone:862-452-7882
Mailing Address - Fax:
Practice Address - Street 1:50 NEWARK AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-1185
Practice Address - Country:US
Practice Address - Phone:973-751-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00297800363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical