Individual
DR. CLIFTON R. LACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
125 PATERSON ST, SUITE 5200, NEW BRUNSWICK, NJ 08901-1962
(732) 235-8966
Mailing address
PO BOX 1458, HIGHLAND PARK, NJ 08904-1458
(732) 821-6810
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
25MA04066100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912003
—
NJ
Enumeration date
05/22/2007
Last updated
07/08/2007
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