Individual
DR. LUKOSE SIMON VADAKARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1401 WHITEHORSE MERCERVILLE RD STE 220, HAMILTON, NJ 08619-3835
(609) 249-6664
(609) 249-6665
Mailing address
21 WILLETTA DR, JACKSON, NJ 08527-4862
(732) 961-6225
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MA69469
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60025158
HORIZON NJ HEALTH
NJ
05
—
8013004
—
NJ
Enumeration date
08/07/2006
Last updated
12/06/2023
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