| Organization Name: | TRICOUNTY PHYSICIAN HOMECARE LLC |
| NPI Number: | 1710221346 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KEVIN E. LUKENDA (D.O.) |
| Mailing Address: | 716 Newman Springs Rd Box 231 Lincroft |
| State: | NJ US |
| Postal Code: | 077381523 |
| Phone Number: | 9089259309 |
| Fax Number: | 9089257910 |
| NPI Enumeration Date: | 11/20/2012 |
| NPI Last Update Date: | 11/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0505X |
| License Number: | 25MBO5511300 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Adult Medicine |
| Taxonomy Definition: | |