NPIMap

Individual provider Active NPI

Michael Jude Lacqua, MD

  • Plastic Surgery Physician
  • Staten Island, NY
National Provider Identifier
1992753883
Registry record updated Mar 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
192446 Issued in NY
Practice address
2372 Victory Blvd
Staten Island, NY 10314-6607
Phone
(718) 761-3700
NPI assigned
May 4, 2006
Last updated
Mar 31, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X 192446 NY Primary

Addresses

Primary practice location

2372 Victory Blvd
Staten Island, NY 10314-6607

Mailing address

2372 Victory Blvd
Staten Island, NY 10314-6607
Phone (718) 761-3700

Other identifiers 1

IdentifierTypeStateIssuer
01710118MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, DE2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110126000123 NY Practitioner - Plastic and Reconstructive SurgeryPractitioner - Hand Surgery 1759560543 Reassigns benefits to 3 organizations
Practice locations: Brooklyn, NY; Staten Island, NY
I20260320002631 DE Practitioner - Plastic and Reconstructive Surgery 1759560543 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2600 Glasgow Ave
Newark, DE 19702-4780

537 Cook St
Delaware City, DE 19706-8754

PO Box
Suite 23
Dittmer, MO 63023

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy18
Upper limb (arm) arthroscopy (minimally invasive joint repair)1-10
Melanoma (skin cancer) excision1-10
Removal of tissue45

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
192446NYMDPlastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Amboy Medical Practice PC CurrentSince Jun 11, 2019 Accepting new patients
New York University CurrentSince Sep 1, 2015 Accepting new patients
New York University CurrentSince Sep 1, 2015 Accepting new patients
NYU Langone Hospitals CurrentSince Jan 11, 2017 Accepting new patients
Amboy Medical Practice PC CurrentSince Jun 11, 2019 Accepting new patients
NYU Langone Hospitals Current Accepting new patients
NYU Langone Hospitals CurrentSince Jan 11, 2017 Accepting new patients
Victory Medical PLLC Plastic Surgery PastSince Jul 1, 2013 Accepting new patients
Pacifico Plastic Surgery Medical PLLC Plastic Surgery Past Accepting new patients

Locations

150 55th St
Brooklyn, NY 11220
Phone (718) 630-7123

150 55th St
Rm 3618
Brooklyn, NY 11220
Phone (718) 630-7477

8714 5th Ave
Brooklyn, NY 11209
Phone (718) 630-8600

301 E 17th St
New York, NY 10003
Phone (212) 598-2454

355 Bard Ave
Staten Island, NY 10310
Phone (718) 818-1380

4434 Amboy Rd
Staten Island, NY 10312
Phone (718) 818-1015

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206921600000",
    "number": "1992753883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2372 VICTORY BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103146607",
            "telephone_number": "718-761-3700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2372 VICTORY BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103146607",
            "telephone_number": "718-761-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACQUA",
        "first_name": "MICHAEL",
        "middle_name": "JUDE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2008-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "NY",
            "license": "192446",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01710118",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.