Provider Demographics
NPI:1588497671
Name:LACASS, BRUCE ANGELO
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:ANGELO
Last Name:LACASS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-3619
Mailing Address - Country:US
Mailing Address - Phone:732-779-6865
Mailing Address - Fax:
Practice Address - Street 1:1924 2ND AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757-3619
Practice Address - Country:US
Practice Address - Phone:732-779-6865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion