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Individual

JACQUES MYRIAMA LUCIEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
800 PARK AVE, FORT LEE, NJ 07024-3771
(908) 659-6250
Mailing address
PO BOX 1084, FORT LEE, NJ 07024-1084
(908) 659-6250

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
402687
NY

Other

Enumeration date
06/25/2019
Last updated
09/24/2019
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