Doctor Name: | DR. NICOLE LYNN LACZ |
NPI Number: | 1306052246 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | |
Business Practice Address: | 20 High St Nutley, NJ - 071101132 |
Business Phone Number: | 9738793964 |
Business Fax Number: | 9732840269 |
Mailing Address: | 777 Passaic Ave, Ste 360 CLIFTON |
State: | NJ |
Postal Code: | 070121800 |
Phone Number: | 9732840020 |
Fax Number: | 9732846310 |
NPI Enumeration Date: | 05/15/2007 |
NPI Last Update Date: | 05/25/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |