1568428977 NPI number — DR. JEFFREY V LUCIDO DPM

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568428977 NPI number — DR. JEFFREY V LUCIDO DPM

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LUCIDO

Provider First Name:

JEFFREY

Provider Middle Name:

V

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

DPM

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1568428977

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

02/22/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

441 77TH STREET

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BROOKLYN

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

11209

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

718-745-3800

Provider Business Mailing Address Fax Number:

718-745-8999

Provider First Line Business Practice Location Address:

441 77TH STREET

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BROOKLYN

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

11209

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

718-745-3800

Provider Business Practice Location Address Fax Number:

718-745-8999

Provider Enumeration Date:

04/25/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 213ES0103X , with the licence number:  N004115 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 113055137 . This is a "AFTRA" identifier . This identifiers is of the category "OTHER".
• Identifier: 113055137 . This is a "1199" identifier . This identifiers is of the category "OTHER".
• Identifier: P746188 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
• Identifier: 000043663 . This is a "GHI HMO" identifier . This identifiers is of the category "OTHER".
• Identifier: 163636 . This is a "ELDERPLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 259850201 . This is a "HEALTHPLUS" identifier . This identifiers is of the category "OTHER".
• Identifier: 030004115NY01 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
• Identifier: 113055137 . This is a "APWU" identifier . This identifiers is of the category "OTHER".
• Identifier: 1C5680 . This is a "PHS" identifier . This identifiers is of the category "OTHER".
• Identifier: 113055137 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 113055137 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
• Identifier: 00968401 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 113055137 . This is a "AIM" identifier . This identifiers is of the category "OTHER".
• Identifier: 113055137 . This is a "ALICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: P43111 . This is a "EMPIRE BC BS" identifier . This identifiers is of the category "OTHER".
• Identifier: 0014397 . This is a "GHI" identifier . This identifiers is of the category "OTHER".