Provider Demographics
NPI:1467447417
Name:LUCASTI, CHRISTOPHER (DO FACOI)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:LUCASTI
Suffix:
Gender:M
Credentials:DO FACOI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2331
Mailing Address - Country:US
Mailing Address - Phone:609-927-6662
Mailing Address - Fax:609-927-2942
Practice Address - Street 1:730 SHORE RD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2331
Practice Address - Country:US
Practice Address - Phone:609-927-6662
Practice Address - Fax:609-927-2942
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB52019207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2243504Medicaid
NJ583591AASMedicare ID - Type Unspecified
NJ2243504Medicaid