Provider Demographics
NPI:1205409828
Name:GREYSON, LUKAS MAVERICK
Entity Type:Individual
Prefix:MR
First Name:LUKAS
Middle Name:MAVERICK
Last Name:GREYSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WYCKOFF ST APT 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6345
Mailing Address - Country:US
Mailing Address - Phone:917-586-4563
Mailing Address - Fax:
Practice Address - Street 1:275 7TH AVE FL 12
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6756
Practice Address - Country:US
Practice Address - Phone:212-604-1730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist