Provider Demographics
NPI:1215035704
Name:LUKE, JOHN CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHARLES
Last Name:LUKE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:177 MAIN ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-6917
Mailing Address - Country:US
Mailing Address - Phone:631-271-5155
Mailing Address - Fax:631-544-9215
Practice Address - Street 1:177 MAIN ST
Practice Address - Street 2:SUITE 206
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6917
Practice Address - Country:US
Practice Address - Phone:631-271-5155
Practice Address - Fax:631-544-9215
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY1311342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB79512Medicare UPIN
NY79D261Medicare ID - Type Unspecified