Provider Demographics
NPI:1275603250
Name:LUGINA, SERGEY (DO)
Entity Type:Individual
Prefix:DR
First Name:SERGEY
Middle Name:
Last Name:LUGINA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 GOODALL ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-3396
Mailing Address - Country:US
Mailing Address - Phone:646-270-8647
Mailing Address - Fax:
Practice Address - Street 1:3049 BRIGHTON 6TH STREET
Practice Address - Street 2:UNIT CU1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6409
Practice Address - Country:US
Practice Address - Phone:718-934-0322
Practice Address - Fax:718-934-0994
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02645494Medicaid
NYH91094Medicare UPIN
NY74V611Medicare ID - Type UnspecifiedFAMILY PRACTICE