Provider Demographics
NPI:1023378049
Name:LUKOSE, BIJU PHILIP (DO)
Entity Type:Individual
Prefix:MR
First Name:BIJU
Middle Name:PHILIP
Last Name:LUKOSE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:57 HAMPTON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-4973
Mailing Address - Country:US
Mailing Address - Phone:631-283-1126
Mailing Address - Fax:631-283-7496
Practice Address - Street 1:470 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-2648
Practice Address - Country:US
Practice Address - Phone:631-329-5900
Practice Address - Fax:631-329-0127
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2015-08-26
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Provider Licenses
StateLicense IDTaxonomies
NY278219207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400125087Medicare PIN