Provider Demographics
NPI:1558020693
Name:DELUCA, LYNDSAY (APN)
Entity type:Individual
Prefix:
First Name:LYNDSAY
Middle Name:
Last Name:DELUCA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 SYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:AVON BY THE SEA
Mailing Address - State:NJ
Mailing Address - Zip Code:07717-2000
Mailing Address - Country:US
Mailing Address - Phone:908-433-0719
Mailing Address - Fax:
Practice Address - Street 1:1350 CAMPUS PKWY
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07753-6821
Practice Address - Country:US
Practice Address - Phone:732-751-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01227900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily