Provider Demographics
NPI:1992762371
Name:CORREIA, LUCY PIRES (NP)
Entity type:Individual
Prefix:MS
First Name:LUCY
Middle Name:PIRES
Last Name:CORREIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3159
Mailing Address - Country:US
Mailing Address - Phone:201-947-5499
Mailing Address - Fax:
Practice Address - Street 1:21 AUDUBON AVENUE
Practice Address - Street 2:FAMILY PLANNING CLINIC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-342-3236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420434-1363LW0102X
NJ26NN08413500363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF420434-1OtherLICENSE #
NJ26NN08413500OtherLICENSE NUMBER
NJ7484003Medicaid