Provider Demographics
NPI:1033365234
Name:LUC, JEAN PHILIPPE (NP)
Entity Type:Individual
Prefix:MR
First Name:JEAN
Middle Name:PHILIPPE
Last Name:LUC
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 LOCUS AVE
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553
Mailing Address - Country:US
Mailing Address - Phone:516-445-5588
Mailing Address - Fax:
Practice Address - Street 1:410 LOCUS AVE
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553
Practice Address - Country:US
Practice Address - Phone:516-445-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401415-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health