Basic Information
| Provider Information | |||||||||
| NPI: | 1548458144 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUCIDO | ||||||||
| FirstName: | SUZANNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35 GERMONDS RD | ||||||||
| Address2: | |||||||||
| City: | NEW CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109562863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2015672277 | ||||||||
| FaxNumber: | 2015672639 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 GRAND AVE | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076314967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2015672277 | ||||||||
| FaxNumber: | 2015672639 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2007 | ||||||||
| LastUpdateDate: | 10/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 010214-1 | NY | Y | Other Service Providers | Specialist |
No ID Information.