1356404511 NPI number — MRS. YEVGENIA LUKOVSKY

Table of content: MRS. YEVGENIA LUKOVSKY (NPI 1356404511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356404511 NPI number — MRS. YEVGENIA LUKOVSKY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUKOVSKY
Provider First Name:
YEVGENIA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

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 Information

NPI Number:
1356404511
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10890 BUSTLETON AVENUE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-676-7622
Provider Business Mailing Address Fax Number:
215-934-7822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10890 BUSTLETON AVENUE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-676-7622
Provider Business Practice Location Address Fax Number:
215-934-7822
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  83594969 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 32324 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0016324220002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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