Individual
ITZA LUGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
181 SUMMIT AVE, CLIFFSIDE PARK, NJ 07010-1123
(201) 667-9161
Mailing address
181 SUMMIT AVE, CLIFFSIDE PARK, NJ 07010-1123
(201) 667-9161
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
L91403776552842
NJ
Other
Enumeration date
11/14/2022
Last updated
11/14/2022
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