Individual
DR. MICHAEL JUDE LACQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2372 VICTORY BLVD, STATEN ISLAND, NY 10314-6607
(718) 761-3700
Mailing address
2372 VICTORY BLVD, STATEN ISLAND, NY 10314-6607
(718) 761-3700
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
192446
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01710118
—
NY
Enumeration date
05/04/2006
Last updated
03/31/2008
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